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.
If that sounds like a mouthful, we’ll break it down.
And if you’re wondering about health coaching in general, how you go about getting certified, and why that even matters, we’ve got 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 is such a big deal.
It’s genuinely exciting to see professional health coaching finally being recognized by the medical establishment.
This is a serious breakthrough for the health coaching industry. It 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 gives 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, gets assigned a code. 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.
In other words, 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 goal is for the health coaching CPT to get re-classified as a Category I. In fact, that’s a bigger picture project for the years ahead.
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 customer 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 customer 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.
A 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?
Join my free legal workshop “5 Steps to Legally Protect & Grow your Online Business” for the basics on how to protect your website, make sure your contracts are solid, and get paid on time. Snag your spot now!
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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.