Couples therapy can be a lifeline for many relationships, providing tools and guidance to navigate the turbulent waters of partnership. Despite its proven benefits, insurance reimbursement for couples therapy remains a complex subject that often causes confusion. In this post, we’ll clarify why insurance reimbursement for couples therapy requires designating one partner as the patient — a model that does not reflect our relationship-centered approach at Steffen Counseling Services (SCS).
Couples therapy, also known as marriage or couples counseling, including discernment, premarital, sex therapy, and separation counseling, is a specialized form of psychotherapy designed to help couples resolve conflicts, improve communication, and build healthier relationships. It is widely recognized for its effectiveness in addressing issues such as communication breakdown, trust issues, intimacy concerns, and more. In fact, various research studies have found that premarital counseling can actually reduce the risk of divorce (we found figures to range between a 17% and 50% reduction in divorce rates). In spite of this, insurance companies don’t cover this relational treatment, for reasons described below.
Insurance Coverage for Relational Therapy: The Core Issue
Insurance companies generally offer coverage for mental health services, including therapy. Some insurance plans will reimburse “family therapy” codes for relationship distress. However, to do so, one partner must be designated as the “identified patient” whose insurance is being billed.
This structure does not reflect how SCS practices couples therapy — where the relationship itself, not one individual, is the client.
CPT Codes and Diagnostic Criteria
While some insurers reimburse CPT 90847 (family therapy with the patient present) when paired with diagnosis Z63.0 (relationship distress with spouse or partner), both codes require designating one partner as the identified patient — with the other treated legally as a collateral participant, not an equal client.
In our couples therapy model at Steffen Counseling Services, both partners are equal clients and the relationship itself is the focus of treatment. Because insurance billing demands assigning one person ownership of the medical record, legal control of notes, and treatment status, using insurance would fundamentally alter our relational approach — so we do not submit claims even when a plan technically allows reimbursement.
Medical Model vs. Relational Model
Insurance billing operates within a medical model, which treats mental health conditions as individual medical diagnoses. Couples therapy, however, is based on a relational model, focusing on interaction patterns and shared growth rather than one person’s symptoms.
When billing insurance, therapists must document an individual diagnosis that justifies treatment. Once the focus shifts to relationship issues — rather than a specific mental health condition — the service no longer fits neatly into that medical model.
This doesn’t mean insurers “don’t cover” relationship distress; rather, it means their structure doesn’t align with how true couples therapy operates.
Billing Compliance and Risk
As in-network providers with Premera, we must assign accurate CPT codes and diagnoses for all sessions billed to insurance. If insurance claims don’t accurately reflect how therapy is being conducted, insurers may deny claims, request refunds, or audit records.
To avoid placing our clinicians or clients at risk, SCS does not submit insurance claims for couples therapy. This ensures our documentation, billing, and therapeutic model remain consistent, ethical, and legally sound.
Alternatives and Solutions
Even if insurance reimbursement isn’t an option, couples have several ways to make therapy affordable:
- Self-Pay: Many couples opt to pay for therapy out of pocket. While this can be a financial commitment, it ensures privacy and autonomy in choosing the therapist. SCS offers couples therapy between $65-$180/session, based on experience level and training. Our self-pay options can be found on our website.
- Employee Assistance Programs (EAPs): Some employers offer EAPs that provide a limited number of counseling sessions for employees and their partners. These programs may cover couples therapy in certain cases. For example, Lyra EAP will cover up to 25 sessions per year, and our owner and resident sex therapist, Brittany Steffen, is in-network with Lyra.
- Sliding Scale or Reduced-Fee Services: At Steffen Counseling Services, we offer an affordable option in the form of our clinical internship program. Our interns offer relationship therapy at our sliding scale rate of $65-$85 per session, which can be less than a copay, depending on your insurance plan.
- Health Savings Accounts (HSAs) or Flexible Spending Accounts (FSAs): Health Savings and Flexible Spending Accounts can often be used to pay for couples therapy with pre-tax dollars. SCS provides appropriate invoices for documentation needs.
Bottom Line for Couples
Some insurance plans technically reimburse relationship-focused sessions — but only by designating one partner as the patient. At Steffen Counseling Services, we treat the relationship itself as the client. Because that model does not align with the insurance system’s structure, we choose not to use insurance for couples therapy.
Our priority is to keep therapy relational, ethical, and centered on the partnership’s health — not on an insurance billing framework.
We invite you to visit our Insurance FAQ page for more information on our insurance policies, or reach out to one of our providers if you’re ready to get started with couples therapy.