Why is Relationship Counseling self-pay only at Chosen Path Collective?
Most insurance plans won’t cover relationship counseling unless one partner is given a mental health diagnosis and the therapist can prove that the work is primarily focused on treating that diagnosis. We don’t believe relationships need to be pathologized to receive care. We also hold ourselves to the highest ethical standards and we won’t submit claims with inaccurate diagnoses in order to get reimbursed. Your health records should be honest and accurate.
Billing ethically for couples and relationship therapy means recognizing your relationship itself as the client and not labeling one person as ‘disordered’ to justify coverage. The accurate billing code for relationship concerns, Z63.0 (‘problems in relationship with spouse or partner’), isn’t covered by the insurance companies we have worked with, nor others in our field.’ The unique circumstances in which insurance companies will pay for a couple to be in the session together are very limited. Such as when one person (the primary patient) is seeking psychotherapy for their depression or anxiety, and once in a while, their partner comes into sessions to help their loved one with their anxiety, depression, or another medically necessary diagnosis. Some therapists will write this up as one patient in the room, regardless of how frequently they both attend.’ (Credit and references to: Key Insights Counseling)
Insurance companies are not built to support family systems and relationship counseling, they require a diagnosable mental health condition for reimbursement that follows the medical model of medical necessity as a mental health disorder.
Even if one of you has a diagnosable condition like depression, anxiety, or PTSD influenced by relationship struggles, ethically and therapeutically, couples and relationship counseling must focus equally on all partners and their interactions, not solely on one person’s disorder. Highlighting only one partner’s condition misrepresents the true nature of our work together and can inadvertently create imbalance, resentment, or confusion within the therapeutic relationship.
While we don’t agree with the decision insurance companies have made because it does actually create a barrier to care, we are required to follow their policies. We know that relationship distress causes significant challenges for individuals and the family systems. However we cannot commit insurance fraud or risk compromising ethical practices in this way. For these myriad of reasons, we cannot bill insurance companies for your relationship/couples/marriage counseling sessions unless we receive written proof that your insurance company covers and reimburses the ICD-10 code: Z63.0 as the primary and sole diagnosis listed for claims.
Here are some factual resources that have helped inform our decision on relationship counseling:
- United Healthcare Inappropriate Primary ICD-10-CM Diagnosis Codes List: ‘A list of ICD-10-CM diagnosis codes that are inappropriate to be used as the primary diagnosis. This list applies to both outpatient and professional submitted claims.’
- United Healthcare Diagnosis Code Requirement Policy, Commercial Reimbursement: Z-codes only as secondary; primary usage causes denial. ‘Factors that influence health status (Category of codes beginning with Z) describe the reason for the encounter. Certain Z codes may only be used as first listed or principal diagnosis. Other Z codes may only be listed as a secondary code based on the circumstances of the encounter.’
- CMS Exclusion List: Z-codes excluded from Section 111 valid reporting. ‘Not all code types are added to the valid lists. For example, ICD-9 codes beginning with the letter “V” and ICD-10 codes beginning with the letter “Z” are removed from the valid lists. ICD-9 “V” codes are equivalent to ICD-10 “Z” codes (e.g., factors influencing health status and contact with health services). These “Z” codes, therefore, are also excluded from Section 111 claim reports.’
- Centers for Medicare & Medicaid Services Office of Minority HealthMS Z-Code Study: Z63.0 used for documentation, not reimbursement. ‘Z code claims are not generally used for payment purposes.’
- SAGE Clinical Journal: Challenges in Diagnosis in Couple and Family Systems Work. The Family Journal, 28(1), 103-109. Diagnoses must be clinically justified, not insurance-driven. ‘To create a diagnosis for financial reimbursement is a fraudulent and an unethical practice. Listing medical psychotherapy as a service when it was not provided is fraudulent billing and it is illegal.’
- ICD-10 Version 2019: Factors influencing health status and contact with health services (Z00-Z99): ‘Categories Z00-Z99 are provided for occasions when circumstances other than a disease, injury or external cause. When some circumstance or problem is present which influences the person’s health status but is not in itself a current illness or injury. Such factors may be elicited during population surveys, when the person may or may not be currently sick, or be recorded as an additional factor to be borne in mind when the person is receiving care for some illness or injury.’
Ethical resources that have helped inform our decision on relationship counseling and insurance billing:
- American Association of Marriage & Family Therapy Code of Ethics: ‘Marriage and family therapists make financial arrangements with clients, third-party payors, and supervisees that are reasonably understandable and conform to accepted professional practices. 8.4 Truthful Representation of Services. Marriage and family therapists represent facts truthfully to clients, third-party payors, and supervisees regarding services rendered.’
- American Counseling Association Code of Ethics: ‘Public Responsibility – C.6.b. Reports to Third Parties Counselors are accurate, honest, and objective in reporting their professional activities and judgments to appropriate third parties, including courts, health insurance companies, those who are the recipients of evaluation reports, and others.’
