Navigating the Insurance Maze

The Therapist’s Complete Guide to Working with Insurance – And Whether You Should

with Barbara Griswold, LMFT

Barbara Griswold, LMFT

Navigating the Insurance Maze

The Therapist’s Complete Guide to Working with Insurance – And Whether You Should

with Barbara Griswold, LMFT

update on couples and family advocacy oct 29 2025

UPDATE:  My Couples and Family Therapy Advocacy Project

By Barbara Griswold, LMFT (October 29, 2025)

Many of you have asked about the status of my advocacy project to get higher reimbursement rates for couples and family therapy sessions (read more about this here and the very interesting survey results here).

Since June, I have been working VERY hard, gathering proof that the current CPT code structure for couples and family sessions often leads to lower reimbursement rates for these sessions, which in turn often leads providers to resign from (or not join) networks, which harms both therapists and clients.

OK, I’ve been obsessed. I designed a survey about the problem that over 3300 therapists responded to (thanks!). I learned all I could about the American Medical Association (AMA) CPT Editorial Panel, the folks that approve changes to the CPT codes. I carefully studied their Code Change application, and previous failed applications. I attended a CPT Editorial Panel meeting to get application tips.

I tried to locate evidence-based research to support why current CPT codes were inadequate. I wrote compelling responses for each question in their application. I reached out to SimplePractice for claims data payment patterns. And I met with leaders from the American Association for Marriage and Family Therapy (AAMFT), the American Psychological Association (APA), the American Counseling Association (ACA), the California Psychological Association (CPA), and the California Association of Marriage and Family Therapists (CAMFT) to get their support (I couldn’t reach the NASW).

However, after talking to the APA, my project has hit a roadblock.  I was made to see that my proposal had little chance of being approved by the Editorial Panel, for two main reasons:

  1. Because changes to the couples and family CPT codes would require a reexamination of ALL therapy codes, and a recalibration of the costs associated with them, an extensive process the Panel would be unlikely to undertake for 2 codes.
  2. The APA hopes to engineer a major overhaul of ALL therapy CPT codes. While details are unclear, they hope to put together a work group with leaders of the major professional associations to propose a new CPT code set that would solve many problems with the current codes. Then they hope to consult with the Editorial Panel to get their buy-in before even submitting the proposal, to increase the likelihood of approval.

So, the good news? Our professional associations are generally aware of the problem with the 90847 and 90846 reimbursement issue, and supportive of the change needed in the CPT code structure.

The bad news? Change will certainly take years to bring about.  I am told that due to a certain Medicare contract situation, it would disadvantage therapists if these changes were made in the next 2-3 years.  And it will likely take many meetings of any professional association work group to formulate code changes they could all agree on.

I can’t even begin to describe how disappointed I am. It looks like the only role I can play in this effort is to regularly pester them to make sure this is moving forward. And it is so sad that all the research I did and the data from my surveys may not be utilized.

But worse, it pains me to think that couples and family therapists may have to wait YEARS to see changes, and pains me to think about all the clients this will affect.  But I must accept the fact that my proposal to change CPT codes for couples and family had little chance of passing without the support of these professional associations, who hopefully can put together something that will fix more problems and has a better chance of passing.

In the meantime, what’s your best bet for higher rates for the couples and family therapy sessions? As always, you can ask each insurance plan that you work with for a “raise” for these codes — and other codes, while you are at it. See my article on raises here.

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Barbara Griswold, LMFT is a private practice coach and the author of Navigating the Insurance Maze:The Therapist’s Complete Guide to Working With Insurance — And Whether You Should, 10th edition.  Check out Barbara’s online catalog of helpful online courses, practice forms, and other therapist resources related to insurance, documentation, and running your therapy business here, and subscribe to her free e-newsletter here.