Does Anthem Cover DBT (Dialectical Behavior Therapy)?

The Short Answer

Anthem covers DBT individual therapy; skills group coverage depends on billing and plan specifics. Dialectical Behavior Therapy, developed by Marsha Linehan for borderline personality disorder and severe emotional dysregulation, has four components: individual therapy, skills group, phone coaching, and a therapist consultation team. Anthem (through its behavioral health manager Carelon Behavioral Health) processes each component separately:

• Individual DBT — reliably covered under standard psychotherapy
• Skills group — sometimes covered as group therapy (CPT 90853), sometimes classified as psychoeducation and denied
• Phone coaching — typically included in the individual therapist's fee
• Consultation team — therapist's training; never billed to clients

As with Aetna and most carriers, the friction point is skills-group classification. Confirm in writing how Carelon will process it before enrolling.

Key Takeaways

• Individual DBT is covered on any Anthem plan that covers outpatient psychotherapy.
• Skills group coverage varies — always confirm the CPT code your program uses and how Carelon will process it.
• DBT-trained in-network providers are scarce; Anthem's Carelon directory does not reliably tag DBT specialty.
• Prior authorization is not required for standard outpatient DBT; IOP/PHP levels do require auth.
• Use the Sydney Health app for claims, superbills, and appeals.

What Anthem Covers for DBT

Individual DBT

Billed under standard psychotherapy codes — 90791 (intake), 90834 (45 min), 90837 (60 min). Paid at your plan's standard outpatient therapy rate.

Skills group

• Billed as 90853 (group psychotherapy): Usually covered, often at a lower copay than individual sessions.
• Billed as psychoeducation or health education: Often denied under Anthem/Carelon, as psychoeducation is not a reimbursable behavioral health service.
• Billed as a monthly program fee: Outside insurance entirely.

Ask any DBT program: "What CPT code do you bill skills group under, and has Anthem/Carelon reimbursed it for recent patients?"

Covered conditions

Borderline personality disorder, self-harm, emotional dysregulation, complex PTSD, eating disorders, and substance use are the primary qualifying diagnoses.

In-Network vs. Out-of-Network DBT

In-network

• Use Anthem's Find Care or the Carelon directory
• Neither directory reliably tags DBT specialization; call providers to confirm
• Cross-reference with Behavioral Tech's DBT-Linehan Board or the Linehan Institute directory

Out-of-network

• Individual DBT sessions: $150–$300 cash pay
• Skills groups: $50–$150 per session cash pay
• PPO plans reimburse 50–80% of allowed amount after OON deductible
• HMO plans: no OON coverage

See DBT cost and insurance guide for a detailed breakdown.

Prior Authorization

Not required for standard outpatient DBT. Required for DBT-IOP, DBT-PHP, and residential DBT levels of care.

How to Verify Your Anthem DBT Coverage

Call 1-800-331-1476 or the behavioral health number on your ID card.

Script

1. "What is my copay for individual psychotherapy (90834, 90837)?"
2. "What is my copay for group psychotherapy (90853)?"
3. "If a DBT skills group is billed under 90853, will Carelon reimburse it at my group therapy rate?"
4. "Are there session limits for group therapy specifically?"
5. "Does my plan cover DBT-IOP, and does that require prior auth?"
6. "Is my plan's behavioral health managed directly by Anthem or by Carelon?"

Note the reference number.

Typical Out-of-Pocket Costs for 6 Months of Comprehensive DBT

What to Do If Anthem Denies a DBT Claim

Common denial reasons: skills group classified as psychoeducation; diagnosis insufficient; session count exceeded soft review threshold.

1. Get EOB in writing.
2. Ask provider to call Carelon for peer review.
3. File a first-level appeal within 180 days through Sydney Health.
4. Cite MHPAEA if the denial is modality-specific.
5. External review after internal appeals.

Frequently Asked Questions

Does Anthem cover adolescent DBT (DBT-A)? Yes. Standard codes apply; family involvement sessions bill under 90847.

Does Anthem cover online DBT skills groups? Telehealth group therapy parity generally applies. Confirm the rate matches in-person.

Can I do just individual DBT under Anthem? Yes — "DBT-informed" individual therapy is easier to get fully covered than comprehensive 4-component DBT.

Related Coverage Guides

• Anthem mental health coverage overview
• DBT cost and insurance guide
• About DBT