By Mark Spurlock, LMFT 45318 · Updated October 15, 2026
Sometimes, yes, but it depends on your plan. Most insurers cover couples sessions only when they treat a diagnosed mental health condition in one spouse. That kind of session is billed as family psychotherapy (CPT 90847). Relationship help alone usually isn’t covered, and premarital counseling isn’t.
Your plan is verified through the booking platform before your first session. Private pay is $200 per couples session.
Every plan is different, so please verify your benefits with your plan.
How insurance treats marriage counseling
Health insurance pays to treat health conditions, not “the marriage” as a whole.
One spouse is the “identified patient”
To cover a couples session, insurers generally need a diagnosis that shows the care is medically necessary. That diagnosis belongs to one spouse, called the “identified patient,” and the claim goes under that spouse’s plan.
It’s a billing rule, not a judgment. You both take part fully.
This rule comes from Medicare and standard billing guidance, and commercial plans generally follow it. Each plan sets its own rules, so coverage can differ from one plan to the next.
The 90847 code
Couples sessions billed to insurance usually use CPT code 90847. Here’s how it compares with two related codes:
- 90847: family or couples therapy with the identified patient in the session
- 90846: family therapy without the identified patient, for example when only the other spouse attends
- 90834: individual therapy for one person
The official description of 90847 says 50 minutes. Under the CPT time rule, it can be billed when a session lasts 26 minutes or more. My sessions run 53 to 60 minutes, so they qualify. Some plans set their own time rules.
Tip: when you call your plan, ask whether CPT 90847 is covered rather than asking about “marriage counseling.”
What usually isn’t covered
- Relationship problems when neither spouse has a diagnosis
- Marriage enrichment or “tune-up” sessions
- Premarital counseling
Insurance covers treatment for a diagnosis, and premarital counseling does not have one.
California’s parity law (SB 855)
California’s SB 855 requires health plans to cover medically necessary treatment of diagnosed mental health and substance use conditions. It doesn’t make counseling for relationship concerns alone a covered benefit.
EAP benefits
Some employers offer an Employee Assistance Program (EAP) with a set number of counseling sessions, often with no diagnosis required. If you have one, check with your EAP about what it offers.
Plans I accept for couples sessions
The plan buttons on my find your plan page book couples too. I currently accept:
- Aetna
- Anthem Blue Cross California
- BCBS Massachusetts
- Blue Shield of California, including Covered California plans. Not the same as Anthem Blue Cross.
- Carelon
- Cigna
- Kaiser Permanente
- Magellan
- MHN, the mental health side of Health Net
- Oxford
- Providence, depending on your specific plan
- Sharp Health Plan
- Sutter Health
- TRICARE West
- United Healthcare/Optum
Plan not listed? Use “Book couples with insurance” on my marriage counseling page.
Copays, deductibles and session limits vary, so verify your benefits with your plan.
What it costs without insurance
- Couples session: $200
- Individual session: $150
- Length: 53–60 minutes by secure video, one session at a time
- Sliding fee scale: available. Ask after your first session, or email info@marriageandfamily.com.
Your right to a Good Faith Estimate
Under the federal No Surprises Act, uninsured and self-pay clients have a right to a written Good Faith Estimate at least one business day before the service. If your bill is $400 or more above it, you can dispute it. I give private-pay clients one before the first session. Learn more on my Good Faith Estimate page.
Engaged? Premarital counseling is private pay
- First session: $200
- Then: 4 prepaid sessions for $600, which saves you $200
- Unused sessions are refunded, and a sliding scale is available
See my premarital counseling page.
How to check your coverage in 3 steps
- Pick your plan on my find your plan page.
- Choose a time on the secure booking page.
- The booking platform verifies your plan before session one.
If you’d like to call your plan yourself, ask:
- Who manages my mental health benefits?
- Is CPT 90847 covered, including by video?
- Does my plan exclude marriage or couples counseling?
- Is prior authorization needed, and is there a session limit?
- What’s my copay, and how much of my deductible is left?
Insurance or private pay: which fits your marriage?
Insurance can lower your cost, depending on your plan. It requires a diagnosis for one spouse, which goes on that spouse’s health plan record.
Private pay needs no diagnosis and includes a Good Faith Estimate.
Diagnosis, records and privacy: what to know before you choose
Many married couples use insurance for counseling every day. I’m in network and glad to bill insurance when it fits. This section helps you choose with clear eyes.
The diagnosis goes on one spouse’s insurance record
An insurance claim includes one spouse’s diagnosis, which becomes part of that spouse’s health plan records. That diagnosis is an honest clinical decision I make after assessment. It’s never chosen to unlock coverage. If neither of you meets criteria for a diagnosis, private pay is the honest route.
Insurers can review records
Health plans can ask for documentation to confirm medical necessity when they review claims. This is routine, not a sign of trouble.
HIPAA protections
HIPAA protects your health information. Psychotherapy notes kept separate from the rest of your record get extra protection and generally need your written authorization to be shared. Your diagnosis, treatment plan, symptoms and progress summaries are not psychotherapy notes.
Later insurance applications
Individually underwritten life, disability or long-term care insurers can ask about your mental health history. With your consent, they may get coded medical information through MIB, a consumer reporting agency. MIB says it doesn’t store medical records, and it only has a file on you if you applied with a member company in the past 7 years and something relevant to underwriting was found.
If an MIB report played a part in a denial or higher rate, the insurer must tell you, and you can request your MIB file free once a year. For specific concerns, a licensed insurance agent can help.
The private-pay alternative
Private pay is $200 per couples session. No claim is filed, no diagnosis goes to an insurer, and you get a written Good Faith Estimate before your first session. I still keep a clinical record either way.
Both routes are fine choices. Pick the one that fits your marriage, and ask me if you’d like to talk it through.
If one of you is leaning out of the marriage, read marriage counseling when one spouse wants out.
FAQ
Does insurance cover marriage counseling in California?
Sometimes, yes, when the sessions treat a diagnosed mental health condition in one spouse. These sessions are usually billed as family psychotherapy (CPT 90847). Relationship help with no diagnosis usually isn’t covered. Every plan is different, so verify your benefits with your plan.
Does one of us need a diagnosis for insurance to pay?
Generally, yes. Insurers usually require a diagnosis that shows the care is medically necessary. The claim is billed under one spouse, called the identified patient. It’s a billing rule, not a judgment about either of you. The diagnosis is an honest clinical decision, and both spouses take part fully.
What is CPT code 90847?
CPT 90847 is the billing code for family or couples psychotherapy with the identified patient present. Its description says 50 minutes, but it can be billed for sessions of 26 minutes or more. Code 90846 is used without the patient present, and 90834 is individual therapy.
Does insurance cover premarital counseling?
No. Insurance covers treatment for a diagnosis, and premarital counseling does not have one. In my practice, the Premarital Series is private pay. The first session is $200, then 4 prepaid sessions are $600, which saves you $200. Unused sessions are refunded, and a sliding scale is available.
What if my plan isn’t on your list?
Use “Book couples with insurance” on my marriage counseling page. The booking platform checks whether your plan is accepted before your first session. If it isn’t, private pay with a sliding scale is available.
How much is marriage counseling without insurance?
In my practice, private pay is $200 per couples session. Sessions are 53 to 60 minutes by secure video, one session at a time. A sliding fee scale is available. Ask after your first session, or email info@marriageandfamily.com. You also receive a Good Faith Estimate before you begin.
What is a Good Faith Estimate?
A Good Faith Estimate is a written cost estimate for uninsured and self-pay clients, required under the federal No Surprises Act. You get it at least one business day before your service. If your bill is $400 or more above the estimate, you can dispute it. I provide one before your first private-pay session.
Will using insurance put a diagnosis on my record?
Yes. If you use insurance, one spouse’s diagnosis goes on the claim and becomes part of that spouse’s health plan records, which HIPAA protects. The diagnosis is an honest clinical decision. If you’d rather not file a claim, private pay with a Good Faith Estimate is available.
Ready to start?
Your plan is verified through the booking platform before your first session.
Prefer private pay? See private-pay rates. Engaged? See the Premarital Series. Christian Counseling is available. Read more about Christian marriage counseling.
Mark Spurlock, LMFT, California license 45318. Counseling since 1998. Licensed since 2008. Online counseling for adults and married couples across California.
If you are in crisis or thinking about harming yourself, call or text 988.
