Does Blue Cross Blue Shield Cover Marriage Counseling?

Blue Cross Blue Shield plans generally do not cover marriage counseling as a standalone service, because relationship problems on their own are not a diagnosable medical condition. Coverage becomes possible when one partner has a diagnosed mental health condition and a therapist can document that joint sessions are part of treating it. Whether your particular plan pays depends on how the therapy is billed, how it is documented, and which BCBS affiliate issued your policy.

Why Relationship-Only Counseling Is Excluded

Health insurance is built around treating diagnosable medical and mental health conditions, and BCBS applies a “medical necessity” standard: a service must be essential for diagnosing or treating a condition, not provided for general well-being or convenience.¹ Relationship distress by itself does not meet that bar.

The ICD-10 code for relationship problems, Z63.0, is a “Z-code,” and Z-codes alone generally do not qualify as a basis for reimbursement.² Insurers typically require a formal DSM-5 diagnosis to authorize payment for therapy, and services provided solely for relationship growth or communication skills are explicitly excluded by most plans.³

When BCBS Will Pay for Couples Sessions

The main route to coverage is what therapists call the “identified patient” approach. If one partner has a qualifying diagnosis such as depression, anxiety, PTSD, or an adjustment disorder, and the therapist can show that involving the other partner is clinically necessary to treat it, the sessions may be covered.² The second partner takes part as a “collateral participant” rather than an equal client.

Sessions are billed under CPT code 90847 (family psychotherapy with the patient present, 50 minutes) or 90846 (without the patient present).⁴ Blue Cross and Blue Shield of Texas, for instance, recognizes CPT 90847 in its clinical payment and coding policy and lists Licensed Marriage and Family Therapists as qualified billing providers, though the same policy notes that individual plan documents govern actual coverage.⁵

Documentation carries the whole arrangement. Session notes must focus on the identified patient’s diagnosis, symptoms, and treatment goals, and must explain why the partner’s presence is clinically necessary.² BCBS may request those notes to verify medical necessity.¹

How To Confirm What Your Plan Covers

BCBS is a federation of roughly three dozen independently operated regional companies, so coverage varies by affiliate, state, employer, and plan type.⁶ An employer plan in North Carolina may read very differently from a marketplace plan in Texas. The only reliable answer comes from your own policy.

Start with your Summary of Benefits and Coverage, specifically the “Outpatient Mental Health” line, and check the member portal for plan-specific details.⁶⁷ Then call the member services number on the back of your card and ask:

Does my plan cover CPT code 90847? Asking by billing code is important; asking about “marriage counseling” may be interpreted as relationship coaching and trigger an automatic no.⁸
Is coverage available when the session is tied to a diagnosed mental health condition?
Do I need a referral or prior authorization? HMO and POS plans often require a primary care physician referral before therapy is covered, while PPO and EPO plans generally do not.⁷⁹
Can I see an out-of-network therapist? PPO plans typically allow it at higher cost; HMO and EPO plans generally do not cover out-of-network services except in emergencies.⁹¹⁰
What are my copay, deductible, and coinsurance amounts for outpatient mental health services?

If you get insurance through work, your HR department can usually clarify what the plan covers and whether you have other related benefits.

What You Can Expect To Pay

When couples therapy is covered, cost-sharing follows the plan’s outpatient mental health structure. In-network copays typically fall between $20 and $50 per session, with coinsurance commonly running 20 to 30 percent of the session cost after the deductible is met.¹¹ Deductibles range from $0 to several thousand dollars.

For out-of-network providers, PPO members can usually expect reimbursement at 50 to 70 percent of the usual, customary, and reasonable rate for their area after the deductible is met, which works out to roughly $55 to $100 per session for CPT 90847 in practice.¹² Members typically pay the full fee upfront and submit a superbill for partial reimbursement. Without any insurance coverage, couples counseling generally costs $75 to $200 per hour depending on the clinician and location.¹³

The EAP Shortcut

If your coverage is through an employer, an Employee Assistance Program is often the fastest way to get couples sessions paid for. Many BCBS-affiliated EAPs explicitly include relationship and marital issues and do not require a mental health diagnosis. The trade-off is a small, fixed number of free sessions.

Blue Cross and Blue Shield of Texas, through its ComPsych GuidanceResources EAP, provides three free sessions per issue with no copays or deductibles, and members can then transition to standard BCBSTX benefits to continue with the same therapist.¹⁴ BlueChoice HealthPlan of South Carolina offers three free sessions per person per contract year through First Sun EAP, covering marital and relationship issues.¹⁵ Capital Blue Cross offers up to four sessions per person, renewable after a two-month break, to a cap of 12 per year.¹⁶ Ask HR whether your benefits package includes an EAP and what it covers.

Online Couples Therapy

Some BCBS plans cover online couples therapy through telehealth platforms. Talkspace is in-network with certain BCBS plans and offers couples counseling through live video and messaging, with partners able to join from different locations.¹⁷ The platform reports most insured members pay a copay of $30 or less, and some plans result in no copay at all, though members on high-deductible plans must meet the deductible first.¹⁸ The Blue Cross Blue Shield Federal Employee Program covers teletherapy and telepsychiatry through Teladoc Health in all 50 states.¹⁹ To check your own coverage, ask member services specifically about telehealth coverage for CPT code 90847.

HSA and FSA Dollars

The IRS draws a clean line. Therapy counts as a deductible medical expense, and therefore as an eligible HSA or FSA expense, only when it treats a diagnosed disease or mental illness. The agency has stated that “an amount paid for therapy to treat a diagnosed mental illness is a medical expense, but an amount paid for marital counseling is not.”²⁰ Couples sessions tied to one partner’s diagnosed condition may qualify. Sessions focused purely on the relationship do not.

If Your Claim Is Denied

A denial is not the end of the matter. Under federal law, you can appeal, and the process generally has two stages.

File an internal appeal with your BCBS plan first. You typically have about 180 days from the denial notice.²¹ Include a written statement of why the denial was incorrect along with supporting documentation: your therapist’s clinical notes, treatment plan, and any letter explaining medical necessity.²² The review must be done by someone other than the person who made the original decision.

If the internal appeal fails, you may be eligible for an external review by an independent third party. External reviews are generally available for denials based on medical judgment, and if the external reviewer overturns the denial, the decision is binding and the insurer must cover the treatment.²¹ Your therapist may be able to file on your behalf or provide a supporting letter, and some states run consumer assistance programs that help with the process.

Lower-Cost Options If You’re Paying Yourself

If your plan does not cover couples therapy and the EAP route is unavailable or used up, several options can bring the price down:

Sliding-scale therapists. Many clinicians adjust rates based on income. Slots are often limited, so ask directly when you reach out.²³
Open Path Collective, a nonprofit directory of over 35,000 reduced-rate therapists. After a one-time $65 membership fee, couples sessions cost $40 to $80.²⁴
University training clinics, where supervised graduate trainees provide therapy for as little as $5 to $50 per session.²⁵
Community mental health centers, which often use sliding-scale models or offer low-cost services.
Faith-based counseling through churches and religious institutions, which is frequently free or low-cost, though the counselor may be clergy rather than a licensed mental health professional.²⁶

Directories from the American Association for Marriage and Family Therapy and the American Psychological Association can help you find couples specialists and clinicians who may offer flexible pricing.²⁵

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