In order to qualify for reimbursement, insurance companies must see that there is “medical necessity” for treatment. Medical necessity is satisfied when there is a qualifying mental health diagnosis on file, and unfortunately, many insurance companies do not view “relationship issues” alone as a diagnosable mental health issue.
However, insurance plans can cover treatment if the insured person in the relationship, who we call the “identified patient,” is diagnosed with a mental health condition such as anxiety or depression.
How Does Insurance Cover Couples Therapy?
This depends on whether or not your therapist is in-network for out-of-network. Also, some plans do and do not have a billing code for family and couples psychotherapy with the identified patient present. The typical code for family and couples therapy is CPT code 90847. And so to have insurance cover costs for couples therapy sessions, the following would have to be met:
If your therapist is in-network:
- You must have a mental health diagnosis on file
- Therapist will submit billing to insurance company or through a third-party credentialing company that will then submit to your insurance company
- Therapist must submit claims to insurance using service code 90847
- Therapist must communicate directly with insurance company or an intermediary company that communicates with the insurance company
If your therapist is out-of-network:
- You must have a mental health diagnosis on file
- Therapist will bill you directly for each session
- Therapist will provide you with a Superbill (like a receipt)
- You will then take this Superbill and seek reimbursement from your insurance company separately
- Therapist does not communicate with insurance company
This is why it’s a good idea to ask your health insurance plan:
- If they specifically have coverage for “outpatient mental health family or couple services,” “family or couples therapy,” “domestic relations,” or any CPT codes that would be applicable.
- If you, or your partner, require a mental health diagnosis to be covered, and what that might entail.
- What your deductible, co-payment, and/or limits are for the benefit.
When billed to insurance, couples therapy is typically categorized as therapy with a “family member or couple,” where one person is typically identified as the covered patient with a diagnosis, and the other person is their “spouse/partner.” This is important for a few reasons:
- The mental health information of the “patient” is now visible to the insurance company, sometimes not desired for privacy reasons
- The insurance company can audit the “patient” to determine if the care is “medically necessary” at every session, potentially limiting the amount of therapy you can receive
- If you have an annual mental health benefit or “cap” the number of sessions you can have, this too will apply to couples therapy
- The “focus” of the therapy has to be on the mental health diagnosis instead of the relationship
Due to these limitations, many couples choose to pay out of pocket with cash pay instead because doing so allows for confidentiality and flexibility, avoiding the restrictions and requirements that insurance companies typically place on therapy services.
Why is the cost of couples therapy different between providers?
When paying cash, couples therapy sessions tend to be more expensive than standard individual therapy sessions. Insurance companies often limit couples and family sessions to 50-minutes, and private pay therapists may offer 60-minute and up to 90-minute sessions. Some even offer couples intensives that may span three hours at a time or an entire day. Thus, the time per session is what often contributes to the difference in cost.
Rates can vary greatly depending on the clinician, their years in practice, their years of experience specifically treating couples, and additional trainings specific to treating couples (such as emotionally focused therapy). Typically, those with more advanced degrees (doctorate versus masters) and advanced training in a couples-therapy-specific modality will command a higher rate.
How much does couples therapy cost?
Many couples therapists in high-cost-of-living areas like the Bay Area of California are billing anywhere between $200 to $400 per session.
Some things to keep in mind when budgeting for couple’s therapy:
- The session may be 60-90 minutes, instead of the traditional 45-50 minutes for individual therapy
- Rates might be higher for more experienced or specialized clinicians
- Rates vary drastically by location, especially if you live in the Bay Area or another high-cost area.
- If you pay privately, you may have more flexibility and confidentiality (no preauthorization, diagnosis requirements or limits from your insurance company)
Many therapy practices offer a free phone consultation before your first session, where many billing questions can be answered. It’s a good idea to ask about rates and session length before committing to ongoing care.
If you’re weighing whether to use insurance or pay privately for couples therapy, talking it through during a consultation can help clarify what actually makes sense for your situation.
