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How to Bill Insurance as a Health Coach

How to Bill Insurance as a Health Coach

How to Bill Insurance as a Health Coach

If you’re like most of the health 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 cookie recipe too.

But you most likely did NOT get into the coaching biz because you were excited to calculate 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 went 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, whether you can be a health coach without certification, and why that even matters, I have a great post with info about that here!

Insurance for Health Coaches

As a health coach, you need to look at insurance from two different directions:

  1. You need business insurance for your own health coaching business, in order to be financially secure to work with clients.
  2. Your clients may have health insurance that accepts (or will reimburse for) your health coaching services.

In this post, we’re talking about insurance that your health coaching clients may have. But if you’re looking more for insurance for health coaches (for your actual health coaching business), you’ll want to listen to this episode of my podcast, On Your Terms™️

How Do I 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.

Can You Be a Health Coach Without a Certification?

Yes! There’s no legal requirement for a health coach to have a certification in order to work with clients online or to start a health coaching practice. If you’re a health coach and you want to be accepted by your clients’ health insurance policies, however, they might require you to be a certified health coach. For insurance purposes, you have to be certified by the National Board for Health and Wellness Coaching (NBHWC) or the National Commission for Health Education Credentialing (NCHEC).But to start an online business as a health coach (without insurance)? You don’t need to be certified. Those are extra credentials that don’t expand your scope of practice as a health coach, either. 

Whew! I know this is a lot. So comment below with your questions. I’ve got you covered!

How to Start a Health Coaching Business (Legally!)

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?

Watch my free legal workshop “5 Steps to Legally Protect & Grow Your Online Businessfor the basics on how to legally form your online coaching business, protect your website, make sure your contracts are solid, and get paid on time. You’ll even be able to ask me questions (and yes, you’ll get the replay!).

If this post was helpful or you have any questions for me, comment below 👇

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.

Get my weekly emails with legal tips for your online business, behind-the-scenes insider info on how I’m building my multi-7-figure business and more here! 👇

 

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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.

  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!

  17. Is there a website or resource that can provide guidance in figuring out which CPT code corresponds to an ICD code? I’m assuming an ICD code is always needed to use a CPT code.

  18. How difficult is it to attain an NPI? Also, I only need to be certified through NBHWC or NCHEC? As a BSN/RN for over 22 years, do I also need an AHNCC certification?

  19. 3rd party billing excellent way to go

    I’m an LMT and new certified health coach
    Do you m ow if they complement each other. Or do the acct for credit. I ha NPI and want to add my cHC going forward as integrated health coach. Suggestions when it comes to reimbursement or taking insurance
    Thank you

  20. Great article! I run a coaching company. For NPI, how do I apply for the organization NPI (what’s the difference for individual’s)? How do I apply for it? Need CPI first? Once I have NPI, do I need all of my coaches to have a CPI?

    Thank you.

  21. Hello. This article is good news now so it looks like health coaches will be able to build insurance. Do you know if there is a code for a virtual session that’s available these days in the United states?

  22. Hi, my insurance is requesting a diagnosis code in addition to procedure code listed here. Is this something specific to Cigna? If not, where can I find what a diagnosis code I should be using to get reimbursed? My provider does not know anything about this and I am on my own to try to get reimbursed.
    Thanks a lot

  23. great article, just to clarify does a coach need to be board certified to charge insurance or just up to date in certification?

    1. Thank you for reading! Health Coaches need to be up-to-date in their certification in order to charge insurance. However, you may want to check with some of the major insurance providers in your state to ensure that is the only requirement for a health coach to bill insurance.

      – Leanne, Team Sam Vander Wielen

  24. Thank you so much for this great read it was very helpful i was just wandering what is the difference between a health coach and a life coach if there a difference at all.

    1. Hi Tiarra!

      Thank you for reading Sam’s blog and leaving a comment. Health coaches primarily offer coaching services related to a person’s health – things like diet, nutrition, and self-care. A life coach offers services relating to personal or career outcomes for their clients – maybe a person isn’t fulfilled in their job or life and is looking for help with where to go from where they are. I hope that helps to clarify the purposes of different coaches. 🙂

      – Leanne, Team Sam Vander Wielen

  25. Category III are usually not reimbursed by government plans as Medicare and Medicaid. Also commercial plans usually do not recognize the codes as well. It’s a great step forward though you can not start your own business with billing insurances with Category III CPT codes. Though I am hoping for changing in the upcoming years.

  26. What a great post! And still getting mileage almost 2 years later. I am a health coach and was looking for info related to insurance reimbursement in order to partner with doctor’s offices. This post came up. Great info!!!! Will follow you in IG.

  27. I’m so impressed out of ALL of the advice that you give, that you knew what an NBC-HWC is! I just became certified and am in the midst of setting everything up to start my own practice in January 2023. Thank you for all that you provide!

  28. Do coaches working soley online at a distance qualify to use these CPT codes? I am wondering because it says face to face

  29. Is this information current?
    I read that in March 2019 all forms of alternative health services, such as acupuncture, Yoga, massage, etc. were banned by law from being billed as health services, though these are helpful alternative forms of treatment.
    Health Coaching is different, hopefully. I am a Nurse that just passed my certification in Health Coaching. I work in a clinic setting and I am wanting to help our patients with nutrition information. I feel the Administration would be supportive of this if there was reimbursement for the service.

    1. Hi Veronica,

      This blog post was written in February of 2021, so the information is current as of that date. If you’re working at a clinic, you will want to discuss with them what kind of information you are permitted to provide to patients you consult with.

      Leanne – Team Sam Vander Wielen LLC

  30. Ivery helpful thank you so much
    I have a great experience i have phd from overseas as pshycologist
    I found that working as life coachis the easiest step until i evaluate my degree
    But i have a question for you what are the health insurances that cover a life coach visit?
    According to my research i saw that all insurances companies under medicaid do not cover it.
    Should i go only by cash visit?

    1. Hi Fatima,

      Life coaching is not covered by insurance in the USA. Therefore, your agreement for being paid from your clients is between you and them, and you can setup payments via cash or other methods you may prefer.

      -Leanne – Team San Vander Wielen LLC

  31. Thanks for the info but to my knowledge the health coach codes are not yet approved for reimbursement being that they are still category III codes. Do you have any updates on this? Thanks!

  32. How do I know that once I get certified as a life coach that most insurance companies, that people who are in my service area use, will actually cover and pay for coaching sessions? It only charge $50 for one hour sessions is this headache of billing insurance really going to benefit my clients and create new clients or is their a co-pay that is almost $50 anyway? Any advice will be helpful. Thank you.

  33. Hi,

    Thank you so much for this blog! I’m in a health coaching program and trying to get up-to-date on the developments surrounding Health Coaching and saw that NBC-HWC just applied for the Category 1 CPT code/s so I’m excited about it.

    If it’s approved, do you know if a Health Coach can expect to make as much as a Dietitian or Therapist? I’m asking because I got accepted into a Dietetics program that will cost about 47K and based on the average salaries, they seem to be comparable to a health coach or educator. I wonder if the new codes will also increase the average salaries of Health Coaches.

    Thanks in advance for your insight.

    Best,
    Beliu

    1. Hi Beliu,

      We don’t know the answer to your question, unfortunately. Wages differ from state-to-state, and vary based on certifications and experience, so there’s no way for us to know if these changes might impact the base and/or average salary of health coaches.

      – Leanne, Team Sam Vander Wielen LLC

  34. I have been searching for this information, thank you so very much. I truly appreciate your dedication and willingness to help.

  35. I am working toward my NBHWC certification. I would like to ask a few questions.
    1. Once I am certified, how will I get set up to bill insurance?
    2. Is it best to hire an outside billing agency to bill insurance, or is this worth the cost?
    3. How much do I bill insurance for? Am I billing insurance by the hourly rate or just a set pricing depending on what that insurance covers?
    4. Do you have a list of recommended businesses insurances?
    Thank you
    Kathryn

    1. Hi Kathryn,

      Thank you for reading and commenting on this post! We’ll answer your questions in the order you asked them:

      1) Once you’re certified, you will then get your NPI number, and match the sessions you provide with the relevant CPT number ( you can find a list of CPT numbers here: https://www.findacode.com/code-set.php?set=CPT&i=36629 )
      2) As Sam said in the blog post, it’s totally your call whether you want to hire an outside billing agency or go the DIY route. We haven’t had much discussion surrounding this from our Bundle™ members, so you may want to join a Facebook group for health coaches and ask the people in there if they have a preferred method.
      3) For billing, this will depend on the insurer, the service you’ve provided, and what’s covered under your scope of practice in your state. If you want resources for scope of practice, please email us at [email protected].
      4) You might find a few of Sam’s other blog posts/podcast episodes regarding business insurance helpful:
      Business Insurance Mistakes That Could Cost You Big
      Is Business Insurance Worth It?
      How To Legally Protect Your Online Business
      These resources go over what types of insurance there are so you’re well prepared when you meet with an insurance broker to ask the right questions of them with regard to the type of insurance you’ll need. If you would like a referral for insurance brokers that Sam recommends, please email us at [email protected] to request their contact information.

      – Leanne
      Team Sam Vander Wielen LLC

  36. Great information! Do you know if CMS considers the NPI for Health Coaching valid for Cat I CPT codes? I understand that the AMA states CPTs are not specialty restricted, rather governed by license type for reimbursement. Several of the 97000 series would be appropriate for certain clients – if billed as a certified health coach w/NPI, will these codes be considered for reimbursement by CMS?

    1. Hi Melissa! We recommend you reach out to CMS to determine whether the NPI for health coaching is valid for the category 1 CPT codes. You can search the CMS website for help articles, or find the contact for your state using their /contacts page.

      – Leanne
      Team Sam Vander Wielen LLC

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