Question 1

How should documentation and diagnosis be handled for CPT 90847 in couples therapy?

Accepted Answer

When using 90847, documentation should focus on the identified patient’s condition and how the couple’s session supports their treatment. Your note should include:

The IP’s diagnosis (ICD-10 code)
Clinical objectives tied to the IP’s condition
Session content emphasizing treatment relevance
Any observed dynamics that impact the IP’s symptoms or progress

Avoid centering the note solely on relational issues unless clearly tied to the IP’s diagnosis.

Question 2

Can relational distress alone (without psychiatric diagnosis) be billed using CPT codes?

Accepted Answer

No. Relational distress, including issues like communication breakdowns or conflict, is not considered a billable diagnosis for insurance purposes. To use CPT codes like 90847 or 90846, the session must be part of a treatment plan for a patient with a recognized mental health diagnosis. Z-codes (e.g., Z63.0 for partner conflict) are not reimbursable.

Question 3

Can 90837 or other codes be used for couples counseling if session is 60+ minutes?

Accepted Answer

90837 is an individual psychotherapy code and should not be used for couples therapy, even if the session is 60+ minutes. For longer family or couples sessions:

Use 90847 or 90846 based on IP presence
Add code 99354 for extended sessions beyond 74 minutes if allowed by the payer
Always check insurer rules on time-based billing and add-on codes.

Question 4

Does telehealth couples therapy qualify for CPT 90847 billing?

Accepted Answer

Yes, telehealth couples therapy can qualify for CPT 90847, provided:

The identified patient is present in the session
You follow all HIPAA and payer telehealth requirements
The service is performed on a covered telehealth platform
Documentation supports medical necessity and treatment relevance

Make sure to include appropriate telehealth modifiers (e.g., 95) and confirm the payer covers family therapy via telehealth.

Question 5

If I conduct both an individual and couples session on the same day, how do I bill?

Accepted Answer

You can bill for both sessions on the same day if:

Each session is distinctly documented
They are performed at separate times
You use separate, appropriate CPT codes (e.g., 90834 for individual, 90847 for couples)

Some insurers may require modifiers or deny multiple same-day services, so always verify plan rules and include clear session documentation.