It is a question that comes up a lot in my practice that couples want to utilize their health insurance for reimbursement of our sessions. While some therapists choose to facilitate this type of business, after careful research of insurance practices, and personal philosophies of effective treatment, I forego this as an option.
Using health insurance for a couple, even if they are married and have the same plan, involves identifying one of the individuals as “the patient.” While yes, it is specifically for the purposes of insurance, I don’t want to go down that path. If you have ever been labeled as “the patient” in any of your relationships, you know it doesn’t facilitate openness. The point of couple’s therapy is to, in all facets, see the relationship as the “patient,” and that both partners contribute exactly 50% to the reason they are sitting with me. To do anything otherwise, in any case even just in submission of insurance claims, has an undermining effect. Obviously, in cases of abuse, this 50% number is completely inappropriate, but in that scenario couples therapy is contraindicated.
There are no CPT billing codes that specifically point to relationship therapy as the process. There is “90847: collateral therapy w/ individual present” which sounds okay, but that would still involve identifying one person as the patient and the other as simply a collateral contact, coming into the session to involve in the patient’s treatment.
Lastly, there is a Z63.0 code that is the only diagnostic code that should be used when treating couples. It stands for “Problems in relationship with spouse or partner” and very few insurance companies would cover this. However, these last two issues (billing codes and diagnosis) only apply when we are complicit in identifying the patient.