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How to Bill Insurance as a Health Coach

how to bill insurance as a health coach sam vander wielen legal templates for coaches

If you’re like most of the coaches in our community, you probably got into health coaching for the incredible connection to your clients, the desire to help improve people’s health, and maybe even to perfect that incredible tahini recipe too.

But you most likely did NOT get into the coaching biz because you were excited to tabulate your monthly profit and loss or figure out how to bill your clients’ health insurance for payment, right?

The thing is, your passion for healthy living may carry you the first few yards of the game, but having a sustainable stream of revenue helps you finish the game on top in a successful business. And being able to bill insurance may provide you with one of those revenue streams that helps your health coaching business stay afloat.

Just recently, there was some amazing news for health coaches wondering how to bill insurance as a health coach: the American Medical Association (AMA) approved three “Category III” codes for Health and Well-Being Coaching, which go into effect in April, 2021. 

I know, I know, it’s a mouthful. 😉 I promise I’ll break down all those acronyms and mysterious words if you’ll keep reading to the end of this article, so you can get started billing insurance too.

And if you’re wondering about health coaching in general, how you go about getting certified, and why that even matters, there’s plenty of helpful info about that here!

How to Bill Insurance as a Health Coach

But before we get into the nitty gritty, here’s why this announcement from the AMA is such a big deal.

Whether you love it or hate it, the codes that the health care system uses to bill insurance give a stamp of “legitimacy” to professional health coaching, showing that it’s finally being recognized by the medical establishment. 🙌🏽 Which may be great news for your coaching business!

Here’s why this is a serious breakthrough for the health coaching industry: the announcement means that insurance companies will now reimburse the cost of health coaching services (big yay). This also helps establish health coaching as a “respected, esteemed career path for those who want to change lives,” according to the Institute for Integrative Nutrition (even bigger yay). Hopefully, this will give more people than ever access to vital and potentially life-changing health coaching services (biggest yay!).

The best-case scenario is that the new codes help level the field and present opportunities for wellness coaching and also improve health outcomes in a big, meaningful way.

What Are CPT Codes Anyway?

Current Procedural Terminology/Technology, or CPT® codes for short, are AMA’s five-digit tools for coding medical services and procedures to streamline reporting and efficiency in the United States. Every service a practitioner provides, from a diagnostic session with a therapist to surgery with a physician, gets assigned a code. The practitioner can then use these codes when completing their charts on the patient as well as in their billing. Thousands of codes are in use, and they also get updated every year. Insurers then use these codes to determine how much they will reimburse practitioners.

Think of it these CPT codes like a dictionary of sorts for health care professionals and the insurance companies. If you go on vacation to Mexico and you don’t already speak Spanish, if you want to order those mouth-watering chilaquiles, you’ll need a dictionary or translator tool (which pulls all of those words from said dictionary) to make that magic happen. Without a common language to use, it would be impossible to order that delicious meal and you’d forever wonder what your life could have been like if you’d only known how to ask for them in Spanish. (Trust me, that is not a fate you want to live out. Chilaquiles will change everything for you.)

Just like using that trusty Spanish dictionary to build a bridge between you and that steaming pile of fried brothy corn tortillas — anybody else getting hungry here? — these CPT codes are a way to make sure everyone in the healthcare system speaks the same language. So if you’re getting a general check-up from your physician, the corresponding code is 99213 or 99214. Easy as pie! (Er, theoretically.)

There are three categories of CPT codes:

Category I code:

Procedures, services, devices, and drugs, including vaccines

Category II code:

Performance measures and quality of care

Category III code:

Services and procedures using emerging technology.

Category III codes, including the new health and well-being coaching codes, are temporary codes created for “data collection of the use of emerging technologies, services, procedures, and service paradigms over a five-year period,” according to the AMA.

Which CPT codes are approved for health coaches?

For now, the approved Category III Health and Well-Being Coaching 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 (two or more individuals), at least 30 minutes

For coaches, the ultimate long-term goal is for the health coaching CPT to get re-classified as a Category I. In reality, that’s a bigger picture project for the years ahead. However, there’s still a process you can follow to bill insurance even for the current Category III services you may be providing your clients.

How to Bill Insurance as a Health Coach

Step 1: Make sure your certification is up to date

AMA defines a health coach as a “non-physician health care professional certified by the National Board for Health and Wellness Coaching (NBHWC) or the National Commission for Health Education Credentialing (NCHEC).”

In order to be able to submit CPT codes to get insurance reimbursement for health coaching, practitioners need to be certified by either of these professional organizations. So pop over here to read about becoming a Board-Certified Health Coach.

Step 2: Register for your NPI Number

The National Provider Identifier (NPI) is a Health Insurance Portability and Accountability Act (HIPAA) administrative standard. It’s a 10-digit, national unique identification number for health care providers. Credentialed health educators and coaches—both individuals and organizations—are eligible to submit an application for an NPI number.

Step 3: Provide your client with the information they need

Each insurance company has different rules and criteria for which services they will cover, and how much they will pay for each code or combination. (It’s the wild west out there!) If your client is submitting to insurance for reimbursement, match the sessions you provide with the relevant CPT code.

Then if you’re approved to be in-network with an insurance provider, the company will walk you through their billing requirements.

One quick suggestion: If you’re submitting to one or two insurance companies, you might go ahead and do so yourself online. The process can be complicated though, so if you are working with several providers, using a third-party biller is probably the best way to go.

Whew! I know this is a lot. So please reach out with your questions. I’ve got your back.

Bonus (but equally important) step: Legally protect your business

It’s hard enough to start and grow your own business; you certainly don’t need to worry about legal mistakes or potential loopholes. Who has time for that?

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And before you go, if this post was helpful, leave a short comment below 👇 so I know what kind of content you love to read here.

Any questions? Drop those in the comments below too 👇

Talk soon!

Note: Remember, this isn’t legal advice. Although I’m a lawyer, I’m not your lawyer — under any circumstances. This article is for informational and educational purposes only. It is not intended to supplement or replace seeking advice from your own attorney. Do not take health coach scope of practice advice or tips from anyone other than a licensed attorney. I see a lot of bad / false information circulating online and social media, and it’s very dangerous to blindly accept non-lawyer advice.

39 Comments
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  1. Thank you! I’ve been trying to decide what program to apply to. My FMD suggested I check on reimbursement first. This was very helpful,

  2. Hi Sam – thanks for the information. Wondering if you know or have any information on where Canada is at with submitting health coaching to insurance?

    1. Hey Nicole! Thanks so much for reading 🙂 I’d first recommend getting in touch with any Canadian health coaching/wellness coaching certification bodies to see if they have any resources or information about which insurance companies, if any, are reimbursing for coaching. They should have info for you! If not, I’d reach out to a local healthcare attorney who focuses on healthcare/business issues who should be able to research this issue for you and see whether you could get reimbursed. You could also ask your clients to contact their insurance companies to see if they’re reimbursing (but being sure never to promise reimbursement as part of your services, of course!). I hope that’s helpful! Have a great week 🙂

  3. Hi Sam,

    Thanks for all this great information! Once a coach is board certified and has an NPI number, how do you then submit for insurance reimbursement? Does the client do that themselves and your invoice then reflects the CPT codes, or can the coach then go through the credentialing process with their local insurance providers to bill insurance first?

    1. Hey Katelyn! Thanks so much for reading & leaving your question 🙂 So assuming you’re out of network (unless you’re an in-network provider for the client’s insurance company), you’d likely have to have the client submit your ‘super bill’ for reimbursement from their own insurance company.

      If you want to go in-network with a certain insurance company, I’d get in touch with them to find out what that process looks like.

      If you want to take on clients and have your clients submit for reimbursement, I’d do everything you did already (board certification + NPI) and then have the client reach out to their insurance company *first* to make sure they’re clear on what the reimbursement process AND amount would look like. Not that you would, but one doesn’t want to make any promises or make it seem like the client will receive a certain reimbursement when really it’s up to the insurance company to decide. By having the client reach out to their insurance company first, there won’t be any miscommunication or regrets 🙂

      Hope this helps!

      Best,
      Sam

  4. Do you have a listing of US Health Insurance Plans that cover the WHC fee schedules 0591T, 0592T, and 0593T? Different plans have different maximum $ coverage. Does that mean the charge for the WHC sessions should be according to the health insurance plan that the clients currently have? For example, Medicare may cover only a lowest set point.

    1. Hey Tina! Thanks so much for your comment 🙂 I don’t have a listing of all the insurance plans that cover those fee schedules. I searched for you, but I didn’t find anything that comprehensive. I’d recommend having your clients reach out to their insurance companies and finding out if coaching is covered and if so, for what amount. Some people choose to accept that rate, or charge a higher rate with the client paying the difference.

  5. Great info! What is the reimbursement for the CPT codes you listed for health coaching? That would be really good content to include. I’m considering pursuing this and just want to know what the reimbursement is.

    1. Hey Kay! That’s up the individual insurance carriers. You’d have to have your clients reach out and ask what the reimbursement amount is for their plan.

  6. Fantastic information, thank you! I’ve completed NBHWC approved training and now just need to get the 50 encounter sessions to sit for the board. Since they allow pro-bono sessions for coachees so long as they aren’t friends or family I’m thinking of offering free sessions to other people. I have an NPI but not the coaching taxonomy because I haven’t boarded yet, and I don’t carry any malpractice insurance because my current practice is through a governmental agency. Is there any potential legal exposure for me in this scenario?

    1. Hey Mike! Thanks so much for reading 🙂 So you’d want to consult with your own attorney just to make sure what your legal exposure is (if any) since I can’t give you legal advice on that. But once you’re out on your own and not coaching via your employer, you’d definitely want to get your own insurance! 🙂

  7. Hi Sam! Thank for this information.
    I am a healthcare practitioner (physician assistant) with an NPI number. I have a health coaching business (LLC). While I don’t prescribe medications or order laboratory testing in my health coaching – strictly 1:1 coaching, am I able to use my physician assistant NPI to bill to insurance using the CPT codes above?

  8. Does this apply for life coaches? What certificate would we need to gain in order to bill insurance companies?

    1. Hey Morgan! I think you’d need to follow the steps I outlined in this post and bill yourself as a health coach (meaning you’d be offering those types of services/talking about those types of topics). I don’t know of a life coach equivalent yet – but that doesn’t mean it doesn’t exist! 🙂

  9. I really appreciate that you took the time to write this post. I’m sitting for the board exam in May, but I have my NPI # and liability insurance coverage 🙂 I just wasn’t sure if I needed to be board certified first! Very grateful for your knowledge on this issue!

  10. Thats exciting! I have a 60 hour Masters in Clinical mental health and am also currently doing school counseling as well. I don’t want to go through the whole 3,000 and all the fees to be a LPC. Who can I contact to find out if my education and experience (I also have ran a health and wellness center for 28 years) to see what I need to do to get certified?

    1. Extremely helpful! Third party billing?? How do we find out the max insurance will pay for each service? Are there still services insurance will not cover like Reiki, Spiritual or energy work while we are still operating as a certified Health Coach and coaching school? I have many questions! Thank you for your article!

      Necole XO

  11. Hey Sam,
    Do you know if “face to face” means in-person services?
    I currently conduct most of my services via a secure online health coaching platform called Practice Better and am looking at potentially using super bills so clients can reimburse.

    Thanks for the info, I knew Category Three codes were in use but didn’t know we could use them yet!

    1. Hey Erin! Face to face likely does mean in-person, but with the pandemic a lot of insurance companies have expanded the reimbursement of virtual services (like therapy, for ex!). So I’d have your clients contact their insurance companies to see if virtual services (which is what Practice Better sessions are) are covered 🙂 Hope that helps!

  12. Very informative. Thank you so much. I am going to work on being a nurse coach. I think our credentials will be NCBC will insurance also pay for being a nurse coach?

    1. Thank you so much for letting us know! We’re happy to hear that this post was helpful to you.
      -Leanne, Team Sam Vander Wielen

  13. I am very thankful for this article. Does a health coach need two CPT in order to work with group and Individual at the time?

  14. Wonderful article. Thank you. Can you share a website where I can apply for my NPI number as a Board Ceritified Health Coach? Thank you.

  15. Thank you so much for this information! I haven’t heard of this before, only that if you work directly for an insurance company as a coach, then it’s covered. I’m a Nurse Coach- Board Certified but I’m not yet NBHWC certified yet. Would a board certified nurse coach fall under this same code as a NBHWC? Thanks!

  16. Thank you so much for making this valuable information available, without having to jump through hoops! I am excited to listen to your podcast, read your blog, and shop!

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