Does Blue Cross Blue Shield Cover Couples Therapy?
How BCBS covers couples therapy across its 35 independent companies — the diagnosis requirement, what qualifies, and alternatives when coverage does not apply.
The Short Answer
BCBS covers couples therapy conditionally. Every BCBS plan — like every major U.S. insurer — covers couples therapy only when at least one partner has a diagnosed mental health condition and joint sessions are clinically necessary for that individual's treatment. Pure relationship counseling, marriage enrichment, and premarital counseling are not reimbursable under any Blue.
When covered, sessions bill as family psychotherapy (CPT 90847). The specific copay, network, and OON rules depend on your state Blue.
Key Takeaways
- BCBS covers couples therapy only when one partner has a diagnosed covered mental health condition.
- Sessions bill as CPT 90847 across all Blues.
- Pure relationship counseling without a diagnosis is not covered on any Blue.
- In-network copays typically $20–$60 per session.
- When coverage doesn't apply: EAP, HSA/FSA, sliding-scale providers, or individual therapy with occasional joint sessions.
What BCBS Covers for Couples Therapy
CPT codes
| CPT Code | Description |
|---|---|
| 90847 | Family therapy with identified patient present |
| 90846 | Family therapy without identified patient |
The "identified patient" (diagnosed individual) is the one whose plan is billed.
Covered scenarios
- A partner with depression whose recovery requires relational work
- A partner with PTSD doing couples work as part of trauma treatment
- Substance use recovery involving joint sessions
- Adjustment disorders where couples work is clinically appropriate
Not covered
Marriage enrichment, premarital counseling, relationship conflict resolution without a diagnosis, or general relationship maintenance.
In-Network vs. Out-of-Network Couples Therapy
In-network
- Start at your state Blue's provider search
- Look for LMFTs, Certified Gottman Therapists, or Certified EFT Therapists
- In-network copay: $20–$60 per session
- BlueCard gives access to in-network couples therapists across state lines
Out-of-network
- Cash-pay rates: $150–$350 per session
- PPO Blues reimburse 50–80% of allowed amount for 90847 after OON deductible
- HMO Blues: no OON coverage
How to Verify Your BCBS Couples Therapy Coverage
Call the number on the back of your ID card.
Script
- "What is my copay for family therapy, CPT 90847?"
- "Is there a session limit for family therapy?"
- "Does 90847 require a specific diagnosis on one of us?"
- "If my partner has the diagnosis but different insurance, does that affect my Blue coverage?"
- "Do I have out-of-network benefits, and what is the allowed amount for 90847?"
- "Are telehealth couples sessions reimbursed at the same rate as in-person?"
Typical Out-of-Pocket Costs for Couples Therapy
For a 16-session course:
| Scenario | Per Session | 16-Session Course |
|---|---|---|
| In-network, $30 copay (diagnosis present) | $30 | $480 |
| In-network, $50 copay (diagnosis present) | $50 | $800 |
| In-network without a diagnosis (not covered) | Full fee | $2,400–$4,800 |
| OON PPO, 70% reimbursement | ~$70–$140 post-reimbursement | $2,200+ (year 1) |
| Cash pay | $150–$350 | $2,400–$5,600 |
See couples therapy cost for the private-pay view.
What to Do If Coverage Doesn't Apply
- EAP. Many BCBS employer plans include 3–6 free EAP sessions — often usable for couples concerns without a diagnosis.
- HSA/FSA. Therapy is eligible pre-tax; saves 20–35%.
- Sliding-scale providers. Open Path Collective.
- Individual + joint. Each partner in individual therapy (covered under their own plan), with occasional joint sessions.
What to Do If BCBS Denies a Couples Therapy Claim
- Get the EOB in writing.
- Ask your therapist to peer-review.
- File a first-level appeal within the listed deadline.
- Cite MHPAEA parity if comparable medical family-based treatments are covered.
Frequently Asked Questions
Does BCBS cover Gottman Method or EFT specifically? Neither method has its own CPT code — both bill as 90847. Coverage depends on the diagnostic frame.
Does BCBS cover premarital counseling? No — not a covered medical service on any Blue.
Can my partner and I both use our BCBS plans for the same session? No — only one plan is billed per session, and the claim goes on the diagnosed partner's plan.
Does BCBS cover online couples therapy? Yes, when correctly billed under 90847. Telehealth parity is near-universal across Blues.