Billing for Couples and Family Therapy
May 2014 By Barbara Griswald, LMFT
One of the most common topics of my consultations is how to bill for couples and family therapy. Here are some frequently asked questions:
Do insurance plans cover couples and family therapy? My experience is that most do. But don't assume (ex. one client with ABC insurance may have this benefit and another might not). If it is covered, it will only be covered when the plan feels the treatment is medically necessary to treat a diagnosis, not aimed at relationship growth or communication skills. Therefore, you'll need to have someone in the room who is your identified patient who has a diagnosis (something more than a V-code). So when you call to check coverage don't ask if they cover couples or family counseling (which to them may sound like couples communication work) -- ask if the plan covers CPT code 90847 for a client with a diagnosis.
How is a couples or family session listed on a claim? Choose one client as your Identified Patient (IP) -- if two clients have diagnoses, you might choose the one with the more severe symptoms. If one client is the primary holder of their insurance you might choose him/her. Put the name of your IP on your Superbill/Invoice, or in Box 2 of the CMS-1500 under "Patient's Name" (the name of the primary holder of the insurance goes in Box 4). The CPT code 90847 on the claim reflects a couples or family session therapy session. The names of other session attendees are not listed on the claim. Put only your IP's diagnosis on the claim.
Can I use CPT codes 90832, 90834, and 90837 for family sessions, too? These codes, typically used for individual sessions (30 minutes, 45 minutes, and 60 minutes respectively), can also be used if you bring a family member into your session with the IP. The IP has to be present for part of the session. However, use code 90847 for ongoing couples or family therapy.
What if both members of the couple have insurance?This can be complicated. You'll need to figure out which plan is primary, bill that plan first, then bill the secondary plan, enclosing a copy of the Explanation of Benefits (EOB) from the primary plan which outlines how much they paid.
How would I code it if I saw one member of the couple alone? If you see the IP alone, use a psychotherapy CPT code as you would for an individual session (e.g. 90832, 90834, or 90837). If you see the non-IP family member alone, continue to list your IP as the patient on the claim form, but use CPT code 90846, which is for "family therapy w/o patient present."
What is the time length on the 90847 Couples/Family Therapy CPT Code? This code has no time length. This means if couples/family therapy is a covered benefit, the plan will typically pay the same amount for a couples/family session that lasts 45 minutes or 2 hours.
How is "family" or "couple" defined? Thankfully, it is left open to interpretation. The CPT Code 90847 can be used if the client is seen with a family member, friend, significant other, or anyone in the client's support network.
A final thought? Many insurance plans pay more for couples/family therapy and for intake sessions than for individual therapy. You might want to charge more for these services.
(For more on the subtleties of CPT codes, click here to getmy "Special Report on the 2013 CPT Codes" To read more helpful articles like this, visit my website atwww.theinsurancemaze.com.
To read the full newsletter, please click HERE
One of the most common topics of my consultations is how to bill for couples and family therapy. Here are some frequently asked questions:
Do insurance plans cover couples and family therapy? My experience is that most do. But don't assume (ex. one client with ABC insurance may have this benefit and another might not). If it is covered, it will only be covered when the plan feels the treatment is medically necessary to treat a diagnosis, not aimed at relationship growth or communication skills. Therefore, you'll need to have someone in the room who is your identified patient who has a diagnosis (something more than a V-code). So when you call to check coverage don't ask if they cover couples or family counseling (which to them may sound like couples communication work) -- ask if the plan covers CPT code 90847 for a client with a diagnosis.
How is a couples or family session listed on a claim? Choose one client as your Identified Patient (IP) -- if two clients have diagnoses, you might choose the one with the more severe symptoms. If one client is the primary holder of their insurance you might choose him/her. Put the name of your IP on your Superbill/Invoice, or in Box 2 of the CMS-1500 under "Patient's Name" (the name of the primary holder of the insurance goes in Box 4). The CPT code 90847 on the claim reflects a couples or family session therapy session. The names of other session attendees are not listed on the claim. Put only your IP's diagnosis on the claim.
Can I use CPT codes 90832, 90834, and 90837 for family sessions, too? These codes, typically used for individual sessions (30 minutes, 45 minutes, and 60 minutes respectively), can also be used if you bring a family member into your session with the IP. The IP has to be present for part of the session. However, use code 90847 for ongoing couples or family therapy.
What if both members of the couple have insurance?This can be complicated. You'll need to figure out which plan is primary, bill that plan first, then bill the secondary plan, enclosing a copy of the Explanation of Benefits (EOB) from the primary plan which outlines how much they paid.
How would I code it if I saw one member of the couple alone? If you see the IP alone, use a psychotherapy CPT code as you would for an individual session (e.g. 90832, 90834, or 90837). If you see the non-IP family member alone, continue to list your IP as the patient on the claim form, but use CPT code 90846, which is for "family therapy w/o patient present."
What is the time length on the 90847 Couples/Family Therapy CPT Code? This code has no time length. This means if couples/family therapy is a covered benefit, the plan will typically pay the same amount for a couples/family session that lasts 45 minutes or 2 hours.
How is "family" or "couple" defined? Thankfully, it is left open to interpretation. The CPT Code 90847 can be used if the client is seen with a family member, friend, significant other, or anyone in the client's support network.
A final thought? Many insurance plans pay more for couples/family therapy and for intake sessions than for individual therapy. You might want to charge more for these services.
(For more on the subtleties of CPT codes, click here to getmy "Special Report on the 2013 CPT Codes" To read more helpful articles like this, visit my website atwww.theinsurancemaze.com.
To read the full newsletter, please click HERE
What EVERY Therapist Should Know About Insurance
(Even if You Want Nothing To Do With It)
January 2014 By Barbara Griswold, LMFT
Navigating the Insurance Maze: The Therapist's Complete Guide to Working With Insurance -- And Whether You Should
Eight Great New Year's Tips
Well the new year is here. Besides taking time to put away holiday decorations and throw out that dead tree that's becoming a fire hazard, what does this mean for you? A few New Year's tips:
1. Ask all clients if they have new insurance and/or get a copy if they received a new card.
2. Call the insurance plan of each client to verify coverage. Copayments, claim addresses,deductibles and other details may have changed (my book has a helpful worksheet "12 Essential Questions to Ask when Checking Coverage" -- to order the book,click here).
3. Don't make the costly mistake of making assumptions or trusting clients who say there have been no changes in their coverage. They aren't always aware of changes.
4. When you call the plan, ask about the deductible, the amount the client must pay out of pocket before the insurance starts to pay. Many clients saw huge increases in deductibles in 2014, and so if you are only collecting a copayment this may be a mistake. Also ask how much of the deductible has already been met (to read my article about deductibles,click here)
5. Don't assume you are a provider on your client's plan - verify this, especially if the plan was purchased through a state or federal exchange, since some of these plans are using restricted provider lists.
6. Don't wait until the end of the month to submit claims. I usually submit after the first time I see someone in Janauary. The sooner you submit, the sooner you'll find out about coverage problems.
7. As of January 6th, you should be able to use the new CMS-1500 (version 2/12) claim form. In fact you should be able to use either the old version (08/05) or new version until April 1st, when you will be required to use the new one. However, it is wise to check with any plan before submitting the new form to be sure they are ready to process claims on it. To buy the forms, visithttp://theinsurancemaze.com/store/index.html
8. It is not too late for uninsured clients (or therapists without insurance) to sign up for health coverage -- visit www.healthcare.gov before3/31/14.
To read more helpful articles like this, visit my website atwww.theinsurancemaze.com.