Exploring the Use of Health Benefits for Couples Therapy

Couples therapy helps partners navigate mental health, substance use, and relationship challenges that often overlap.

Yet for many couples, the first question isn’t about commitment or compatibility: it’s financial: is couples therapy covered by insurance?

The answer depends on the type of insurance, who’s receiving treatment, and how the therapist structures the care.

While health insurance may cover sessions when they address a diagnosable condition such as anxiety, depression, or substance use, coverage for relationship counseling alone is less certain. Understanding how insurers view “medical necessity” is key to knowing what’s included.

If all this seems a bit thorny, this is where our expertise at Couples Rehab Guide shines! Keep reading to get all the details you need to know, and to find the details you need!

Why Insurance Coverage Matters for Couples Therapy

Therapy can be life-changing, but ongoing sessions can add up quickly. Many couples balance therapy costs with other financial responsibilities, mortgages, childcare, or student loans, making insurance coverage a determining factor in whether they seek help.

For couples facing mental health or addiction-related concerns, the stakes are even higher. The ability to use health insurance can make consistent care accessible, helping partners maintain progress and stability.

What Insurers Mean by “Medical Necessity”

Most insurance companies only pay for therapy that addresses a diagnosable mental health or substance use condition listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). If a session’s primary goal is improving communication, trust, or general relationship satisfaction, it may not qualify.

However, if one or both partners are being treated for depression, trauma, anxiety, or addiction, and couples therapy is part of that treatment plan, coverage is much more likely. The key is documentation: a mental health professional must note how the therapy supports the diagnosed condition.

Is Couples Therapy Covered by Health Insurance?

When people ask, “Is couples therapy covered by health insurance?”, they’re really asking how their plan classifies the service. Most insurance companies categorize therapy under mental and behavioral health benefits. Within those benefits, the therapist’s billing approach determines whether sessions qualify.

For example, if the therapist bills under one partner’s diagnosis code – such as generalized anxiety disorder – the session is considered individual therapy with the partner present. That coding choice often satisfies the insurer’s coverage criteria, even though both partners attend.

If the therapist bills purely for “relationship counseling” without a diagnosis, the insurer typically denies the claim.

Common Coverage Scenarios

1. One Partner Has a Mental Health Diagnosis

If one partner is diagnosed with a condition like depression or PTSD, and couples sessions are part of treatment, most plans cover it. The therapist bills under that diagnosis.

2. Substance Use or Recovery Support

In the context of addiction treatment or recovery support, couples therapy can play a clinically recognized role. Sessions help partners rebuild trust, set boundaries, and support relapse prevention—factors often viewed as medically necessary.

3. Preventive or Relationship-Focused Counseling

If the purpose is improving communication or resolving general conflicts, coverage is unlikely. In that case, couples pay out of pocket unless their plan offers limited wellness benefits.

What Types of Plans Offer Health Insurance Coverage for Couples Therapy?

Every plan handles behavioral health differently. Here’s how coverage usually breaks down:

• Employer-Sponsored Health Plans: Often provide mental health benefits that include couples therapy if one partner’s diagnosis qualifies.
• Marketplace or ACA Plans: Must include mental health and substance use services as essential benefits, but reimbursement still depends on diagnosis and provider coding.
• Medicaid and Medicare: Some state Medicaid programs cover family or couples therapy when medically necessary, while Medicare may cover it only under specific clinical conditions.
• TRICARE or Military Insurance: Often covers marriage and family therapy when delivered by licensed professionals for behavioral health conditions.

Reading the “behavioral health services” section of your plan’s benefits summary is the most direct way to find out what’s included.

In-Network vs. Out-of-Network Coverage

Another layer of complexity lies in the provider network. In-network therapists have pre-established rates with the insurer, reducing out-of-pocket costs.

Out-of-network therapists may still be covered, but reimbursement is lower and requires filing claims manually.

For couples seeking privacy or specialized care, out-of-network providers sometimes offer the flexibility needed to integrate both relationship and addiction-related work, even if coverage is partial.

Couples Therapy in Addiction and Mental Health Treatment

Our team at Couples Rehab Guide also wants to highlight how relationship-focused therapy is often integrated into treatment for substance use and co-occurring disorders.

In these programs, sessions go beyond improving communication—they address codependency, relapse dynamics, and emotional regulation within the partnership.

Because these sessions are tied directly to recovery outcomes, they’re usually covered under behavioral health or substance use disorder benefits. This makes health insurance coverage for couples therapy far more attainable when treatment occurs in a clinical setting or as part of a continuum of care.

How Providers Bill for Couples Therapy

Therapists use specific codes when submitting claims to insurance. Common ones include:

• 90847: Family psychotherapy with the patient present (used for couples).
• 90846: Family psychotherapy without the patient present.

The diagnosis and session notes must support that the therapy addresses a recognized disorder. If the therapist instead uses code V61.10 (relationship distress with spouse or partner) without another diagnosis, most insurers deny payment because it’s not viewed as medically necessary.

Out-of-Pocket Costs When Insurance Doesn’t Apply

If your insurance plan doesn’t cover couples therapy, costs vary by provider and region. Average rates range from $120 to $250 per session, though some clinics offer sliding scales or package discounts.

Couples therapy through online platforms may offer lower costs or monthly subscription models. However, reimbursement depends on whether the platform provides a superbill with proper diagnostic coding.

How to Check Your Benefits Before Starting

1. Review your plan documents for “behavioral health” or “mental health services.”
2. Contact your insurer and ask:
   • Are couples or family therapy sessions covered?
   • What diagnosis codes qualify?
   • What’s the copay or deductible?
   • Are telehealth sessions covered?
3. Confirm with your therapist that they can bill under a qualifying diagnosis and are credentialed with your plan if in-network.

Knowing this upfront helps avoid surprise bills and ensures continuity of care.

Telehealth and Couples Therapy Coverage

Since 2020, many insurers have expanded telehealth benefits to include couples and family therapy. For partners managing privacy, work schedules, or distance, online sessions can be a flexible option.

When sessions occur via secure video platforms and meet clinical standards, they are usually covered under the same codes as in-person therapy.

When Coverage Is Denied: What You Can Do

If an insurer denies coverage, couples have options:

• Request an Explanation of Benefits (EOB) to see why the claim was denied.
• Ask the provider to resubmit with additional documentation or a different diagnostic code, if appropriate.
• File an appeal with supporting notes from your therapist demonstrating clinical necessity.

Persistence can pay off: many denials result from administrative or coding issues rather than lack of eligibility.

Reach Out for Support as a Couple Today to Get Needed Help

So, is couples therapy covered by insurance? Sometimes yes, sometimes no: but context matters. When therapy supports a diagnosed condition or recovery plan, insurers are more likely to approve it. When it focuses purely on relationship improvement without a diagnosis, coverage is less likely.

Couples seeking support should begin by reviewing their mental health benefits, verifying therapist credentials, and understanding how their sessions will be billed.

Resources like our offerings from Couples Rehab Guide seek to help demystify the process so couples can focus on what matters most, healing together, and we hope our guide has proven to be of use.

If you and your partner are experiencing a higher level of difficulties than therapy alone can address, we are standing by to help! All calls are confidential, so please reach out today!

References

American Psychological Association. Does your insurance cover mental health services? Retrieved from https://www.apa.org/topics/managed-care-insurance/parity-guide American Psychological Association

Centers for Medicare & Medicaid Services. Mental Health Parity and Addiction Equity Act (MHPAEA). Retrieved from https://www.cms.gov/marketplace/private-health-insurance/mental-health-parity-addiction-equity

SAMHSA & CMS. Understanding Parity: A Resource for Behavioral Health and Insurance Coverage. Retrieved from https://library.samhsa.gov/sites/default/files/pep21-05-00-002.pdf library.samhsa.gov

HealthCare.gov. Mental health & substance abuse coverage. Retrieved from https://www.healthcare.gov/coverage/mental-health-substance-abuse-coverage/ HealthCare.gov

CMS. Coverage of Mental Health and Substance Use Disorders (fact sheet). Retrieved from https://www.cms.gov/marketplace/technical-assistance-resources/coverage-mental-health-substance-use-disorders.pdf CMS

MacPAC / Medicaid. Implementation of the Mental Health Parity and Addiction Equity Act in Medicaid and CHIP. Retrieved from https://www.macpac.gov/wp-content/uploads/2021/07/Implementation-of-the-Mental-Health-Parity-and-Addiction-Equity-Act-in-Medicaid-and-CHIP.pdf