How Health Coaches Can Be Reimbursed by Medical Insurance

dr. cheng ruan Feb 13, 2022

As the new health coaching taxonomy took effect in April of 2021, health coaches began receiving reimbursements for services under the same codes used for psychological assessments and other behavioral health services.

This allowed doctors to bill insurance in their private practice for assessments by health coaches rather than using billing codes for their other allied health providers like psychologists, psychiatrists, social workers or counselors.

Let's break down how this occured.

The AMA's creation of behavioral health CPT codes went into effect on 01/01/2020 which included behavioral assessment and intervetion as part of its scope. The origin of these CPT codes were from previous CPT Codes that designated health assessment and behvaioral services specifically by licensed and credentialed psychologists.

However, on 09/01/2021, on the CMS website, the language was updated and removed the language that “Health and Behavior Assessment/Intervention services may only be performed by a clinical psychologist”. This now opened behavioral intervention services to other specialties, which is perfect timing to address lifestyle factors during the global pandemic.

The changes discussed above have already begun to take place. Health coaching may now be covered under the new behavioral health assessment and management reimbursement structures which reduces the barrier between independent coaches by allowing them to be legally employed in medical practices with direct billing access to insurance companies.

Health coaches are the archetypal behavioral assessment and intervention professionals. They hold the social determinants of health data as well as the relationships needed for behavioral change for patients.

Doctors are beginning to realize they need help in understanding what really works against chronic disease treatment and prevention. Most chronic diseases in this country is directly correlated to behavioral patterns.

This realization is leading doctors to seek alternative ways beyond the traditional patient interaction. The era for health coaches is just beginning.

If you're a doctor in private practice who is passionate about helping your patients become their own heroes, I encourage you to sign up for the Integrative Practice Builder, which is my online course that covers not only health coach billing, but also all aspects of scaling an integrative medicine practice while taking in-network medical insurance (including Medicare and Medicaid).

This content in this Journal / Blog Post Reflection is not approved for credit by CMEfy, however, you may reflect on how it applies to your day-to-day and engage to earn AMA PRA Category 1 Credit(s)™ from point-of-care learning activities here: 


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