Coding for couple's therapy?

[reca]

Hey everyone, got a question about coding for insurance and wasn't sure who to ask (is this a question to pose to my malpractice carrier?). Had a request to do couple's therapy. I had a fair amount of elective training in couples therapy during residency and have done some additional training at the Gottman institute. However, I'm unsure about how, if at all, to bill this to insurance. During residency, I would bill 90847 instead of E/M codes but my supervisor was a psychologist so I couldn't have billed an E/M code in the first place (I think).

If I'm seeing someone for couple's therapy, would it be 90847 or would it be a 99213 + 90836? In this case, one of the members of the couple does have a diagnosable psychiatric condition that is affecting the relationship (ADHD). If neither had a psychiatric condition that was affecting the relationship, would I then not be able to bill insurance?

Thanks in advance!

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[TexasPhysician]

Generally couple’s therapy is all cash based. Insurance focuses on personal medical issues with individual diagnoses.

 

[reca]

Thanks, I appreciate it!

 

[clausewitz2]

Generally couple’s therapy is all cash based. Insurance focuses on personal medical issues with individual diagnoses.

In my area insurance covers couples therapy all the time. I don't know the details of the codes but it's simply not true that it's a 100% cash market, at least in some places.

 

[TexasPhysician]

In my area insurance covers couples therapy all the time. I don't know the details of the codes but it's simply not true that it's a 100% cash market, at least in some places.

The CPT code is 90847. If your insurance covers it, I’ve always seen it be reimbursed less than the associated individual therapy codes. Therapists and well almost everyone hate being paid less for navigating 2x the issues. I think it was 20% less last I looked. The result is that I can’t find anyone in my area that does insurance couple’s therapy.

My understanding is that E&M would apply if individual therapy. 90847 is not an add-on code from what I’ve seen.

 

[clausewitz2]

The CPT code is 90847. If your insurance covers it, I’ve always seen it be reimbursed less than the associated individual therapy codes. Therapists and well almost everyone hate being paid less for navigating 2x the issues. I think it was 20% less last I looked. The result is that I can’t find anyone in my area that does insurance couple’s therapy.

Got it. In this area the big payors must be more generous because practically all of the insurance-taking therapy groups around seem to offer couples as well as individual and my patients haven't had a hard time finding it.

 

[TexasPhysician]

Got it. In this area the big payors must be more generous because practically all of the insurance-taking therapy groups around seem to offer couples as well as individual and my patients haven't had a hard time finding it.

If I look at my best payor on a side project I’m working on:

90847 would pay me about $130
99213 + 90838 for the same hour with an individual would pay me >$220

This is not ideal for maximizing revenue by any means, but $130/hr before expenses eliminates every sane psychiatrist from accepting insurance for couple’s therapy.

Even assuming I were a counselor, a 90837 would get me about $155. Specialized Gottman training isn’t cheap. All that to make $25 less per hour. At 2,000 hours, that is a pay cut of $50k for advanced training.

 

[calvnandhobbs68]

If I look at my best payor on a side project I’m working on:

90847 would pay me about $130
99213 + 90838 for the same hour with an individual would pay me >$220

This is not ideal for maximizing revenue by any means, but $130/hr before expenses eliminates every sane psychiatrist from accepting insurance for couple’s therapy.

Even assuming I were a counselor, a 90837 would get me about $155. Specialized Gottman training isn’t cheap. All that to make $25 less per hour. At 2,000 hours, that is a pay cut of $50k for advanced training.

Ah insurance companies, classic logic. If it's twice as complicated, it should pay 20% less. You could literally make more in 5 minutes pulling a bead out of someone's nose in urgent care.