In 2019, the American Medical Association (AMA) approved the creation of Category III CPT codes for health and well-being coaching, a change initiated by the National Board for Health and Wellness Coaching (NBHWC). These codes became effective on January 1, 2020, thereby acknowledging health coaching as an essential aspect of client care. Now, with Medicare's recognition of these codes, health coaches have a clear pathway to seek reimbursement for their services, marking a significant step forward for the healthcare industry at large.

What are CPT codes?

CPT (Current Procedural Terminology) codes are essential for healthcare providers to accurately describe services and procedures and ensure standardized reporting for insurance claims. These codes enhance the accuracy and efficiency of healthcare practices. In the past, there were no CPT codes specifically for health coaching, meaning that clients often couldn’t use insurance to cover these services. This change will help increase access to health coaching, allowing more clients to benefit from these types of services.

The new CPT codes for health coaching

The AMA defines health and well-being coaching as the process where a qualified coach helps clients set and achieve their goals. The new Category III Health and Well-Being Coaching CPT codes include:

• 0591T – Health and Well-Being Coaching: Face-to-face, individual initial assessment
• 0592T – Individual follow-up session (at least 30 minutes)
• 0593T – Group session (two or more individuals, at least 30 minutes)

These codes are a critical advancement, offering a structured way for health coaches to bill insurance providers for their services.

Note: The AMA may alter the descriptors for these codes during the 5-year data collection period.

Health and well-being coaching: what’s involved?

Health coaching is a client-centered approach where clients set their own goals, work alongside a coach using self-discovery, and develop intrinsic motivation to achieve sustainable health changes. The process involves education, self-monitoring, and behavioral change techniques, all within the context of a supportive interpersonal relationship with a coach.

To use the new CPT codes, coaches must have specific credentials, including education, training, and certification from recognized organizations.

CPT Category III codes: temporary but important

The AMA releases Category III codes to allow data collection on emerging services, technologies, and procedures. These codes are intended to track the effectiveness of newer services and support their potential approval for broader use. However, it's important to understand that these codes are temporary and do not guarantee insurance reimbursement.

In the case of the new health and well-being coaching codes, the AMA has made it clear that inclusion of these codes does not imply endorsement of the procedures or services, nor does it ensure reimbursement from insurance companies. Each payer—whether Medicare, Medicaid, HMOs, PPOs, or other private insurers—decides if and when to reimburse health coaching services based on their own policies.

Currently, these services are currently on the Medicare Telehealth Services List and are assigned a provisional status. CMS is not proposing to assign them to the Medicare Telehealth Services List with permanent status for 2025. 

Are the new Category III Coaching codes reimbursable?

The Category III codes for health and well-being coaching are temporary and are primarily intended for data collection. Currently, whether these services will be reimbursed by insurance payers remains at the discretion of each individual payer. While some may choose to offer reimbursement, others may wait for the codes to be classified as Category I codes before considering reimbursement.

This process is similar to how other services and technologies are evaluated before they receive full reimbursement.

Billing for coaching services: the NPI requirement

For health coaches to bill for their services, they need a National Provider Identifier (NPI) number. An NPI number is issued by Medicare and Medicaid Services and is required for all HIPAA-qualified providers. The NPI distinguishes between individual healthcare providers (e.g., physicians, chiropractors, and physical therapists) and organizations (e.g., group practices, hospitals, and clinics).

Health coaches must ensure they meet the certification and credentialing requirements of organizations like NBHWC or NCHEC to use these CPT codes. More details about NPI numbers and the required steps for providers can be found here.

What does this mean for the health coaching industry?

The inclusion of these new CPT codes is a game-changer for health coaching. It paves the way for health coaches to bill for their services and gain recognition within the broader healthcare system. While the codes are currently temporary, there is significant potential for them to be upgraded to Category I status which would allow for broader reimbursement.

Professional organizations and credentialing bodies like the Institute for Integrative Nutrition (IIN) and NBHWC are optimistic that this will drive more growth in the field, expand job opportunities for coaches, and improve client access to high-quality care.

Get started with telehealth services through Healthie

If you're a health coach looking to integrate these new CPT codes into your practice, Healthie can help. Our platform makes it easy to manage telehealth services, client data, and more. Start your free trial today to see how Healthie can support you in navigating this new landscape and expanding your reach in the health coaching industry.