While most patients will pay out-of-pocket expenses for health coaching, others may qualify to have their coaching sessions covered by their health insurance or flexible spending accounts. Being able to bill insurance for coaching-related services increases the availability of your services to reach more patients.
If you are a practitioner that takes health insurance, you might be wondering how you can bill for health coaching?
Current procedure terminology (CPT) codes are used to streamline billing to insurers. These codes make up the uniform language for medical services and procedures. CPT codes have three main categories, labeled as Category I, II, and III.
As of January 1, 2020, CPT codes went into effect specifically for Health Coaching. These new codes are in Category III, which means that they are temporary for “data collection, assessment, and in some instances, payment of new services and procedures.”
The approved Category III codes for Health and Well-Being Coaching include:
Some of the other new CPT codes that may also fall under Health Coaching services include:
While not all insurance companies recognize Health Coaching as a billable service, the good news is that Health Coaching services could shift from the temporary Category III to the permanent Category I codes.
That may happen when data successfully show that services are being used and meet the requirements of Category I codes, another good reason you should submit bills to your patients’ insurance company for data collection purposes, even if you are not reimbursed. With more proof showing that patients want and need health coaching, insurance companies may decide that it is a necessary service that is reimbursable.
In the meantime, you can potentially have patients use their flexible spending account (FSA) or health savings account (HSA) funds to pay for health coaching services.
Health Coaching is a relatively new and quickly evolving profession, and the field is just starting to establish standards for practice. While there are many training programs that certify coaches, not all of them are recognized by credentialing organizations and approved by the American Medical Association (AMA) for billing purposes.
The AMA has noted that only professionals certified by the National Board for Health and Wellness Coaching (NBHWC) or the National Commission for Health Education Credentialing (NCHEC) can use the new CPT codes.
The National Board for Health & Wellness Coaching (NBHWC) is the non-profit arm of the National Board of Medical Examiners that is setting the standards for Health Coaching. The National Commission for Health Education Credentialing (NCHEC) certifies health education specialists, promotes professional development, and strengthens professional preparation and practice.
You may be more successful at billing for health coaching services if you or your staff are certified by a program that is approved by the NBHWC and the NCHEC. As of 2021, those programs include the following schools and certifications: