More than half the consultations I give these days seem to be to couples therapists nationwide. While they are calling for advice, I think they are also looking for encouragement and support. They want to keep providing affordable care for their couples by taking their insurance. But it is an uphill battle.

First, we all know that couples therapy is intense work. Difficult work. Balancing the needs of two emotional people can be draining. It takes a lot of skill, and often specialized training. So most clients would probably be surprised to learn that insurance companies typically pay less for an hour-long couples therapy session than for an hour-long individual session – sometimes as much as $50 less.

Why is this? I blame the American Medical Association (AMA), who determined that the couples and family therapy CPT code 90847 would be a 50-minute code instead of a 60-minute code. How they decided this is a mystery to me. Then, they decided that the code would have an official minimum of 26 minutes (can ANYONE do a couples session in 26 minutes?).

But I also blame the insurance plans, who probably then decided they could not reimburse the couples code the same as a 90837 60-minute individual code, since the 90837 has a threshold minimum of 53 minutes. The outcome? Couples therapy – which in my opinion should be paid at a higher rate than individual therapy due to the greater complexity – is generally reimbursed at a lower rate. Sometimes as much as $50 less.

Or maybe the real issue is that insurance plans (and the world at large) has never really seen the true value of couples therapy, and supported it as they should. If they did, perhaps the AMA would have created three CPT codes for couples therapy, equivalent to what we have for individual therapy: That is, a 30-minute, a 45-minute, and 60-minute couples and family therapy code. The insurance plans could then assign reimbursement rates equivalent to individual therapy. I imagine the AMA would say they did not do this since the 90847 is not billed as often as individual codes. However, in my opinion this is a poor excuse.

Another challenge for many couples therapists is that they want (or need) to do sessions longer than 60 minutes. With two clients, there is often more ground to cover. More history to take. For many couples, progress can be made more rapidly with longer sessions. For others, we utilize techniques that take more session time. But longer sessions are not something insurance usually reimburses, and the Prolonged Services codes that used to exist for this were deleted in January, meaning that couples therapists often are not paid for any additional therapy time (to read more about billing for longer sessions, click here).

I don’t have a lot of answers. Today, I just want to say that something needs to change, and soon. We need to start supporting our couples therapists, and find ways to even the playing field so at least they get as much for their sessions as individual therapists. If not, we are going to see even more of these fabulous clinicians resigning from insurance plans, making their valuable services less accessible to the general public. But just for this moment, let me send a little love to all you couples therapists that do accept insurance, despite the MANY ways our insurance system seems to make it hard for you to do so.

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I hope you will join me as I discuss these challenges, how to overcome them, and as I provide support for all of you out there doing essential couples work at my upcoming live webinar “Couples Therapy Blunders: Common Mistakes When Billing, Documenting, and Handling Ethical Dilemmas”, on October 21, 2023, sponsored by the Zur Institute. Topics will include:

• Will Insurance Cover Couples Therapy? The “Three Hoops” Required
• Must You Choose an Identified Patient?
• What If Neither Client Has a Diagnosis?
• Common Billing Mistakes When Billing For Couples
• Can You Refuse to Bill Insurance for Couples?
• Double Billing for the Same Session and Fraud
• Billing For Longer Sessions
• What Should Be in Your Couples Progress Note and Treatment Plan
• What Should Be in Your Informed Consent with Couples?
• Telehealth With Couples: Considerations
• Ethical Issues, including Playing Multiple Roles with the Same Couple, Who is Your Client, Bringing a Partner into Individual Work, and No Secrets Policies

For more information or registration, click here (ethics CEs available for many clinicians nationwide). Hope to see you there!