Couples Therapy Billing

Insurance covers treatment of illnesses, including mental illness like depression and anxiety. By definition, illnesses afflict one person at a time.  Insurance is often flexible about how a mental illness is treated, and if a family member/spouse needs to be involved and present in the treatment of the illness, they will usually cover that.  In this scenario, one person is diagnosed (the “primary client”), and the treatment file reflects ongoing treatment for that person’s diagnosis, and the notes reflect that a partner was present to support that treatment. This is usually the scenario insurance companies are referring to when they say they cover couples counseling.

If the person who will serve as the “primary client” is already in individual counseling for a mental health diagnosis, then we cannot bill insurance this way, because they are already receiving individual treatment for that diagnosis.

If the problem being addressed is something like communication challenges, conflict, transitions in the relationship (which is what we typically see in couples therapy), then the above described billing situation would not apply. First, because the couple as a unit is the focus of therapy, then billing insurance as if the couples sessions are treating just one individual is inaccurate and potentially fraudulent. Second, because couples challenges like conflict in communication, infidelity, etc, are not considered a medical illness by insurance companies and are typically not covered. 

*A note, very rarely, we do see some insurance carriers cover this. The way to clarify this with your insurance is to ask if your plan reimburses/covers diagnosis “Z Codes”, specifically the code Z63.0.  All insurance billing must include a diagnosis, and for individuals these codes typically start with “F” (F codes include diagnoses like major depressive disorder, generalized anxiety disorder, etc.).  However, there are a group of relationship related codes that start with Z (such as the example above, which is for “Relationship Distress with Spouse or Intimate Partner”), that most insurance plans exclude.  It is unlikely that your insurance will cover these Z codes, but may be worth checking with your specific plan.   

Unless a Z code is covered by your specific insurance policy, we do not bill insurance for couples counseling at Riverbank Therapy. Out of pocket rates for couples counseling are $150.