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CPT Code for Health and Well being Coaching: Update May 2020

NCHEC continues to explore ways to educate and showcase the role of CHES® and MCHES® to those in the primary care setting. Last year the American Medical Association (AMA) announced the approval of three distinct "Category III" codes for "Health and Well-Being Coaching" which went into effect January 1, 2020.  

AMA defines "Health and Well-being coaching" as 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 coach is defined as a non-physician healthcare professional certified by either the National Board for Health and Wellness Coaching OR the National Commission for Health Education Credentialing, Inc. These Category III codes are considered temporary codes, and have been created for the purpose of data collection, assessment, and in some instances, payment of new or emerging services and procedures that currently do not meet the criteria for a Category I code.  

NCHEC is collaborating with leading organizations to develop a strategy and plan that will help to lead to the transition from Category III codes to Category I codes, with the goal of achieving widespread reimbursement. Some crucial next steps include the encouragement of the utilization of the code set by practicing health and well-being coaches, and research to help move the code from Category III to I which increases the likelihood of reimbursement of services.

A key next step for the advancement of Category III codes is to identify CHES® and MCHES® that:

  1. are currently employed in clinics or healthcare systems.
  2. want to report and track use of the new CAT III coaching CPT codes.
  3. are interested in collaborating to advance the reimbursement of services.

In short, NCHEC is seeking CHES® and MCHES® who work or plan to work as an integrated member of a clinical care team where health and well-being coaching services are or can be referred by a clinician and coordinated with the team's supervision of clinical care.

If you are CHES® or MCHES®-certified and meet the criteria stated above, we invite you to complete the form below so we can connect with you.

View the CPT Code Usage Form

We understand that there are many CHES® and MCHES® who would like to perform health and well-being services and be part of the data collection process, yet are not currently working with physicians or licensed medical providers in a healthcare setting. If this is the case, you may wish to approach local medical providers or clinics to explore this possibility.  

Please use the form link provided below to contact us for information or additional questions that relate to the health and well-being coaching CPT codes.

Submit a Question about CPT Codes for Health Coaching

NCHEC will continue to assist with educating those in primary care on the fact that Certified Health Education Specialists have been academically prepared in behavior change and possess specialized skillsets that truly enhance medical care teams. It is our hope that the implementation of the new CPT codes will open doors and create more opportunities for CHES® and MCHES® in primary care settings.

Posted by Jessica Wessner at 07:47

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