Billing Insurance for Marriage/Family Counseling
We understand that you pay a great deal for your health insurance, and you want it to cover the maximum amount of services possible. However, it is important for anyone seeking couples/marriage/family counseling to take a few minutes to understand what exactly is and isn’t covered and why we can’t bill insurance for these things.
When submitting an insurance claim there are two codes that are given by the counselor and used by the insurance company to make a payment determination – the Diagnostic Code for the mental health or medical issue being addressed, and the CPT/Procedural Code for the length/type of session held. An example of a Diagnostic Code would be for “depression," “anxiety," “relationship issues." Procedural Codes indicate the length of the session and who is in the room at that time.
When you call your insurance to see if “marriage counseling" is covered, the representative will check the CPT/Procedural Code and likely will say that it is covered because they see “Couples/Family Therapy” on their CPT list. But it is the Diagnostic Code that causes the claim to be accepted or rejected. This is not something that they routinely check on when you call ahead of time. However, when the claim is officially submitted as a relationship problem and reviewed, it will be rejected.
If you choose to call your insurance company to check on this, here are the codes that would be used for marital or family therapy: Procedure Codes (90834 – 40-50 minute session, or 90837 – 53-60 minute session) and Diagnostic Code (v61.10 – Partner Relational Problem, or v61.20 – Parent/Child Relational Problem).
There are, in fact, certain situations where insurance will cover both spouses to be in the room at the same time. For example, if one spouse is being treated for anxiety and the other spouse joins them for a session to find out how to help in the middle of a panic attack, this would be a covered claim. Note that the second person in the room is there completely in support of the first person’s diagnosed mental health/medical issue and is not a client.
The insurance company’s bottom line is that they do not view marriage and/or family problems as a “medical” issue – they only reimburse therapists for the treatment of mental illness or medical conditions. Additionally insurance companies are cracking down on therapists who provide couples counseling, so it is important for us to be as ethical as possible in handling these claims and keeping you informed