Policy: Managing Clients Engaged in Both Individual and Couples Therapy

Purpose

To ensure compliance with Maryland Medicaid billing rules while supporting clients who wish to receive both individual and couples therapy.

This process provides clear guidance for Client Services Representatives (CSRs) and Therapists on how to schedule sessions, document appropriately, and maintain separate treatment plans.

Step 1: Gather Information from Client

Ask the client:

“Will both your individual and couples therapy be billed under your own insurance, or does your partner have their own insurance that we can use for the couples therapy?”

Record the response in the client’s intake notes.

If both services will use the same insurance, continue to Step 2.

Step 2: Explain Medicaid Limitation

Inform the client:

“Maryland Medicaid only allows one intake session to be billed per client. Since you’re using your insurance for both services, we’ll schedule one intake for individual therapy. The couples therapist can still do an assessment, but it will be billed as a regular couples session, not a separate intake.”

Document that this was explained to the client.

Step 3: Create and Manage Accounts

1.Create a Separate Couples Account

When a client receiving individual therapy begins couples counseling, create a new patient portal account using the client’s name and tag it as “Couples.”

2.Link Accounts

Link the individual and couples accounts in the portal so they remain associated under the same client record.

3.Insurance and Forms

The couples profile must have:

l Completed insurance information under the Patient Info tab.

l A PAF (Payment Authorization Form) on file if the client has a copay.

l No additional intake forms are required for the couples profile.

Step 4: Scheduling and Documentation

All couples therapy sessions must be scheduled and documented under the couples profile only.

The couples treatment plan will be created and stored in this profile, separate from the individual therapy treatment plan.

Step 5: Clinician Assignment

The couples therapist is assigned only to the couples profile.

The individual therapist remains assigned to the client’s main account for individual sessions.