Can health coaches bill insurance? A quick Google search on the topic may have you feeling a little confused on the topic.
In this post we cover everything you need to know about whether health coaches can bill health insurance – from CPT codes, to NPI numbers, what professional credentials are recognised and what is defined as a billable service. All will be revealed here. Let’s get into it!
Current Procedural Terminology (CPT Codes) – What Are They and Why Are They so Important?
Current Procedural Technology or CPT codes were created by the American Medical Association (AMA), and provide a uniform language for all health and medical services. They’re given to medical and health care services (including medical procedures, tests and counselling) that are performed by doctors and other health care professionals. CPT codes streamline the processing of insurance claims, and are used for data collection and assessment for medical care review.
CPT codes fall into three main categories:
- Category I codes are used for procedures and services.
- Category II codes are used for performance measurements.
- Category III are temporary codes assigned to new and developing technology, procedures and services.
What Are the Approved CPT Codes for Health Coaching?
The AMA has approved three Category III CPT codes for health and wellness coaches:
- 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
As these coaching codes are Category III codes, they are temporary and primarily used for data collection and assessment. They can also be used for payment of new services and procedures that don’t yet meet the criteria for a Category I code. They were brought in on January I, 2020 and are valid for 5 years, with the possibility of renewal or reclassification at this time.
Can Health Coaches Bill Insurance With the Current Category III CPT Codes?
This is the big question that most health coaches want to know. The short answer is – potentially. Reimbursement by payers of Category III codes is optional. But, insurance payers generally only accept Category I claims for reimbursement. These codes are a major step in the right direction for guaranteed payment in the future, for when/if the coaching codes are reclassified to Category I.
Why Are CPT Codes so Important to the Health Coaching Industry?
The current health coaching Category III CPT codes are a major advancement for the health coaching industry as they:
- Open the door for reclassification as Category I codes in the future.
- Signify an acknowledgment of health and wellness coaching as a legitimate and necessary part of the health care system.
- Allow for data collection and assessment of the efficacy and wide spread use of health coaching throughout the United States.
- Set a professional standard for health coaching.
Category I Reclassification – How Does That Work?
The information collected using the current Category III CPT heath coaching codes will be used to make a decision on whether to promote these coaching codes to a Category I.
Assessment of the effectiveness and widespread use of health coaching throughout the United States will be done by the CPT Editorial Board. This board is appointed by the AMA board of Trustees and consists of volunteers who represent a vast array of fields and professions within the health care system. Reclassification of the CPT codes may still be several years away and is not guaranteed.
Who Can Use the Health Coaching CPT Codes?
The professional standardization of who is defined as a health coach, is one of the most exciting developments to come out of the health coaching CPT codes. According to the AMA, a health coach is 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, Inc, (NCHEC).”
Or in other words, in order to submit the health coaching CPT codes a coach must be certified by either the NBHWC or the NCHEC. If you’re a health education specialist with a bachelor’s degree, then you may meet the criteria to sit the NCHEC exam. Alternatively, you can become an NBHWC-certified health coach by following these four steps:
- Graduate from a NBHWC-approved program. There are currently over 115 NBHWC-approved globally, with many of them offering online curriculum. Here at the Primal Health Coach Institute, we offer a comprehensive NBHWC-approved 12-week Master Coach Certification program that aligns with ancestral health principles.
- Log 50 coaching sessions (that run for a minimum of 20 minutes each).
- Complete 4000 hours of work experience (in any field) or hold an Associate’s degree or higher (in any field).
- Pass the National Board Certified Health & Wellness Coach (NBC-HWC) exam.
What Is a National Provider Identifier Number and Do You Need One?
A National Provider Identifier (NPI) is a unique 10-digit government issued identification number for health care providers. Individuals as well as organizations, such as hospitals, pharmacies, clinics and schools can apply for their own NPI numbers. They were created to improve electronic communication of health records as part of the Health Insurance Portability and Accountability (HIPAA) regulations. Health care providers must hold an NPI number for reimbursement of a claim.
Under the current CPT codes, payment from insurance companies is optional. But setting yourself up with an NPI number now, will streamline the process of submitting claims if/when reclassification of the health coaching CPT codes takes place, as they don’t expire or change. Applying for an NPI number is free and the application can be done online.
How to Use Pretax Funds to Pay for Health Coaching Services
Wellness providers play an important role in the health and well-being of the general population. So it’s critical that health and wellness coaching is affordable and accessible to anyone that is in need of it.
If reimbursement using the Category III codes is challenging, then an alternative payment strategy your clients can use to fund their health coaching services is to use their pretax money. Health and wellness coaching is eligible for reimbursement with flexible spending accounts (FSA), health savings accounts (HSA) and health reimbursement accounts (HRA). For this to happen, your client will need a letter of medical necessity from their doctor or health care professional.
As health coaches, we’re passionate about helping others lead a healthier lifestyle. We’re behavorial change experts and we specialize in helping our clients set and achieve attainable goals through habit formation and healthy living. But, in order to make a living out of health coaching, we do need to investigate all revenue paths.
In this post we’ve explored whether health coaches can bill insurance. The quick response to this is – potentially! The current coaching CPT codes are classified as Category III. These are temporary and reimbursement by private payers (such as insurers) is optional, and most insurers will only pay out Category I services. But, the Category III codes are a major step towards reclassification to Category I CPT codes in the future.
Your first step towards billing insurance is to become a certified NBHWC coach. Here at the Primal Health Coach Institute, we run an NBHWC-approved 12-week Master Coach Certification program that will arm you with everything you need to know before sitting the NBC-HWC exam.