How to Write a Compliant Treatment Plan for Family or Couples Therapy

Creating a treatment plan for family or couples therapy is like building a roadmap for the therapeutic journey, describing how you and your clients will navigate challenges and build healthier relationships. This type of treatment plan differs from an individual treatment plan in a few important ways, especially if the sessions will be covered by insurance.

Below is a quick how-to guide on creating insurance-compliant treatment plans for family and couples therapy. That said, the specifics can vary widely between payers, so it’s wise to double-check what's required by any insurance company you’re in-network with.

The “Identified Client” and CPT codes

In most cases, insurers will expect one person in the couple/family to be named as the “identified client”, and that person is required to have a documented mental health diagnosis. Insurers will also look for a clear outline of the therapeutic goals, methods, and progress markers for the couple/family.

Family therapy sessions should be billed under CPT codes 90847 (with the “identified client” present) or 90846 (without the “identified client” present), and the treatment plan should be oriented around the identified client’s condition. This differs from traditional couples counseling, which focuses on relational or marital issues without a mental health diagnosis, and is generally not reimbursed by insurance.

• Family therapy (90847/90846): At least one person is the identified client with a billable diagnosis. The treatment plan must demonstrate how involving family members supports this client’s mental health.
• Couples counseling: Goals often focus on the relationship itself (e.g., improving intimacy, resolving conflicts) without anchoring on a diagnosed mental health condition. These services are typically not covered by insurance and are considered self-pay.

Best Practices for Writing Treatment Plans for Family and Couples Therapy Codes (90846/7)

A strong, compliant treatment plan should include:

1. Demographics & Identified Patient
   • Name, date of birth, and diagnosis of the identified client
   • Names of family members who will participate in sessions
   • Session type (90847 or 90846)Example:Identified Patient: Jane SmithDOB: 01/15/1990Diagnosis: Major Depressive Disorder, Moderate (F32.1)Session Type: 90847 – Family psychotherapy with patient presentParticipants: Jane Smith, spouse Jim
   • Notice that in this treatment example, Jane is listed as the identified patient and has a diagnosis of Major Depressive Disorder. The presenting problem and goals are framed around her mental health, which helps establish “medical necessity” for treatment.
2. Presenting ProblemIn family and couples therapy, the presenting problem refers to the main issue or set of issues that led the clients to seek help. It’s the problem as the family or couple sees it—the conflict, concern, or pattern that’s most pressing or painful. When developing an insurance-compliant treatment plan, it’s important to frame the presenting concerns around the identified client’s mental health condition and how family dynamics impact it.Example: Jane’s depressive symptoms have led to withdrawal and conflict at home. Jim feels unsure how to support her. Family therapy is sought to improve communication and strengthen the home environment in support of Jane’s treatment.
3. Treatment Goals In family and couples therapy, treatment goals outline what the family/couple and therapist are working toward and help track progress. These goals are often broken into phases and build on each other over time. Again, treatment goals must be tied to the identified patient’s mental health while involving family members as part of the support system. Example:
   • Phase 1: Increase shared understanding of MDD and reduce conflict.
   • Phase 2: Develop collaborative coping strategies between Jane and Jim.
   • Phase 3: Create a maintenance plan to support relapse prevention.
4. Objectives & InterventionsObjectives and interventions break treatment goals into concrete, measurable steps. Objectives clarify the “what,” while interventions define the “how.” This structure helps ensure therapy remains goal-oriented, practical, and personalized. As in other sections of the treatment plan, you’ll want to keep the focus on how family participation benefits the identified client’s management of their condition. Example:
   • Objective: Jim will learn and demonstrate two skills for supporting Jane during depressive episodes.
   • Intervention: Therapist provides psychoeducation and models communication strategies during in-session practice.
5. Progress Measures & Discharge CriteriaProgress should reflect improvement in the identified patient’s functioning and the family’s ability to support ongoing care. Discharge criteria outlines the specific conditions that indicate when therapy can be successfully concluded. These criteria help the therapist and clients determine whether the treatment goals have been met and if the family/couple is ready to transition out of therapy.Example: Jane and Jim report reduced conflict, improved use of communication skills, and confidence in managing symptoms together.

Key Takeaways

A compliant family or couples therapy treatment plan helps keep the work on track. By laying out clear goals, strategies, and ways to measure progress, you create a roadmap that supports your clients and keeps sessions focused.

When working with insurance, you will always want to:

• Document an identified patient with a diagnosis when billing 90847 or 90846.
• Frame presenting problems, goals, and interventions around the identified patient’s mental health needs.
• Make family members’ participation part of the treatment plan because it supports the client’s recovery.
• Reserve “relationship-only” work (traditional couples counseling) for private pay, since it is not generally covered by insurance.

If you’re an Alma member, you’ll find it’s easier to write treatment plans of all kinds with our Wiley Treatment Planner tool. These flexible templates simplify the process of creating thorough, diagnosis-driven plans that align with agency and insurance requirements. Because treatment planning is integrated with Alma’s intake forms and progress notes, clinicians can manage their documentation in one streamlined, centralized place.