Coding for Health Coaching Services
CPT CODE Facts
Clinicians and clinical practitioners with NSHC Health Coach Certification will continue to integrate their health coaching skills into practice using CPT and HCPCS Codes currently in use.
CPT CATEGORY III CODES FOR COACHING
The American Medical Association (AMA) determines if a Current Procedural Terminology (CPT) Code is added for a service or procedure. The AMA does not determine if or when a CPT Code is reimbursable, nor does it endorse any service or procedure represented in any code released.
The AMA releases CPT Category III Codes, such as the new Health and Well-Being Coaching codes, as temporary codes to allow for data collection of the use of emerging technologies, services, procedures, and service paradigms over a 5-year period. Category III codes are also intended to substantiate use or to provide documentation for the Food and Drug Administration (FDA) approval process.
From the AMA: “As with CPT Category I codes, the inclusion of a descriptor and its associated code number does not represent endorsement by the AMA of any particular diagnosis or therapeutic procedure or service. Inclusion or exclusion of a procedure or service does not imply any health
insurance coverage or reimbursement policy.”
For more details, refer to AMA Statement: https://www.ama-assn.org/system/files/2019-06/cpt-category3-codes-long- descriptors.pdf
ARE THE NEW CATEGORY III COACHING CODES REIMBURSABLE?
Each individual payer, i.e., Medicare and Medicaid, HMOs, PPOs, and other insurance
companies, decide if and when to reimburse for a CPT code, and which providers may use the
code for billing according to the Payer’s own individual reimbursement policies.
BILLING FOR COACHING AS A PROVIDER
Since the onset of HIPAA qualified Providers are required to have a National Provider Identifier
(NPI) number to bill for services. An NPI number is assigned by Medicare and Medicaid
Services. There are two categories of healthcare providers who have NPI numbers for billing.
-
- Individuals: Physicians, Chiropractors, Advanced Practice Nurses, Dentists, Pharmacists,
Nurse Midwives, and Physical Therapists - Organizations: Group Practices, Clinics, Hospitals, HMOs, Home Health, Ambulance
Companies, Laboratories, Nursing Homes, Pharmacies, Residential Treatment Centers, and
DME Suppliers.
- Individuals: Physicians, Chiropractors, Advanced Practice Nurses, Dentists, Pharmacists,
More about NPI numbers and Providers who may use them: https://www.cms.gov/Outreach-
and-EducaBon/Medicare-Learning- Network-MLN/MLNProducts/Downloads/NPI-What-You-
Need-To-Know.pdf
CATEGORY III CODE DESCRIPTOR. & CPT CODES
Note: The AMA may at any time edit/alter the descriptor during the 5-year data collection period.
Health and Well-Being Coaching
Health and well-being coaching is a patient-centered approach wherein patients determine their
goals, use self-discovery or active learning processes together with content education to work
toward their goals, and self-monitor behaviors to increase accountability, all within the context of
an interpersonal relationship with a coach. The health and well-being coach is qualified to
perform health and well-being coaching by education, training, national examination, and when
applicable, licensure/regulation and has completed a training program in health and well-being
coaching whose content meets standards established by an applicable national credentialing
organization. The training includes behavioral change theory, motivational strategies, communication techniques, health education, and promotion theories, which are used to assist
patients to develop intrinsic motivation and obtain skills to create sustainable change for
improved health and well-being.
0591T Health and well-being coaching face-to-face; individual, initial assessment
0592T individual, follow-up session, at least 30 minutes
(Do not report 0592T in conjunction with 96156, 96158, 96159, 98960, 0488T, 0591T)
(For medical nutrition therapy, see 97802, 97803, 97804)
0593T group (2 or more individuals), at least 30 minutes
(Do not report 0593T in conjunction with 96164, 96165, 97150, 98961, 98962, 0403T)
