A little piece of me dies inside every time I meet somebody my age or younger on blood pressure medications.

Not because the medication is wrong—sometimes it’s exactly what someone needs right now. What gets me is the conversation that almost never happened before they got that prescription. The conversation about what they’re eating, how they’re sleeping, whether they’re moving, what their stress looks like, whether anyone has ever sat down with them and said “let’s figure out what’s actually going on here.”

That conversation is what health coaches do. It’s what I’ve spent over 2,000 clinical hours doing—and what thousands of NBC-HWCs across the country do every day. We sit with people. We listen. We help them connect the dots between their symptoms, their habits, and their goals. We walk alongside them through the slow, unglamorous work of actually changing their lives.

The problem is, most people don’t know we exist. And even when they do, they can’t use their insurance to pay for it.

That’s starting to change—slowly, imperfectly, and with a lot of work still ahead. Here’s where things stand, and why I think every health coach and every person who’s ever wished their doctor had more time should be paying attention.

The short version of a long fight

The push to get health coaching recognized as a reimbursable service has been building for years, led largely by the National Board for Health and Wellness Coaching and a coalition of more than 70 healthcare organizations, including the Veterans Health Administration and the American College of Lifestyle Medicine.

In 2019, the American Medical Association approved the creation of Category III CPT codes for health and well-being coaching—three codes that went into effect in January 2020. If you’re not familiar with CPT codes, they’re essentially the universal language that healthcare providers use to bill insurance. Without them, a service effectively doesn’t exist in the eyes of the system.

Category III codes are temporary, though. They’re designed for data collection—a way for the system to track how the service is being used and whether it produces meaningful outcomes. They’re a foot in the door, not a seat at the table.

In late 2023, CMS took the next step by adding health coaching to the 2024 Medicare Telehealth Services List—provisionally, through at least 2027. That meant, for the first time, there was a pathway for health coaching services to be billed through Medicare, even if actual reimbursement remained at the discretion of individual payers.

Then, in the summer of 2025, CMS included health coaching in the disease management and prevention section of their 2026 Physician Fee Schedule and actively solicited public comments. That’s significant—it signals that CMS is evaluating whether coaching belongs as a permanent part of chronic disease management, not just an experimental add-on.

Around the same time, NBHWC representatives met directly with a senior policy advisor at CMS to discuss the framework for broader coverage. The coalition has been building their case methodically: outcomes data from the VHA (which has delivered nearly 150,000 documented coaching sessions), peer-reviewed evidence supporting coaching’s effectiveness for diabetes, hypertension, obesity, and COPD, and utilization data from a collaborative project between NBHWC, NCHEC, and UC San Diego.

What they’re actually asking for

The coalition’s proposals are specific and practical—this isn’t a vague request for “recognition.” Here’s what’s on the table, based on what I’ve seen from public submissions and the broader advocacy conversation:

Existing chronic care management CPT codes (99490 and 99439) already cover care coordination and patient engagement. The ask is to update CMS guidance so that health coaching—motivational interviewing, structured goal-setting, behavior change support—is explicitly recognized as an eligible service under those existing codes. No new infrastructure required; just clarification that what coaches do already fits within what these codes describe.

Beyond that, the coalition is pursuing dedicated HCPCS codes specifically for health coaching services—an initial assessment session, follow-up sessions, and group sessions. These would create a standalone billing pathway rather than requiring coaches to fit their work into codes designed for other services.

There’s also a push for outcomes-based accountability. Patient-voice documentation—where the patient’s own goals and reported outcomes are tied to biometric measures—would be part of how coaching effectiveness is tracked and evaluated. This is important because it aligns with how coaching actually works: it’s collaborative, patient-driven, and measured by real-world changes in the person’s life.

Why this matters beyond the billing codes

I want to be careful here, because it’s easy for this topic to sound like it’s about coaches wanting to get paid more. That’s part of it—I’m not going to pretend otherwise—but it’s not the heart of it.

The heart of it is access.

Right now, if someone wants to work with a health coach, they’re almost always paying out of pocket. That means health coaching is effectively a service for people who can already afford it. The people who arguably need it most—those managing multiple chronic conditions, those in underserved or rural communities, those who keep cycling through 15-minute doctor’s visits that never get to the root cause—they’re the least likely to have access.

Medicare reimbursement changes that equation entirely. It means the person with prediabetes who can’t afford a $200/month coaching program could have coaching covered as part of their care plan. It means the veteran dealing with PTSD and metabolic dysfunction has a documented pathway to get coaching support through the system, not just through the goodwill of a VA program. It means the 55-year-old with hypertension, high triglycerides, and no idea where to start gets a human being who will sit with them for more than 15 minutes.

In my experience working at Revero’s metabolic health clinic, I’ve seen what happens when patients get that kind of sustained, personalized support. Lab markers shift. Medications get reduced or eliminated. People start showing up differently—not just in their health numbers, but in how they talk about their own agency and capacity for change.

That’s not something a prescription can replicate. It’s not something a 15-minute annual wellness visit can deliver. It takes time, relationship, and the kind of structured behavioral support that health coaches are specifically trained to provide.

Where things stand right now

As of today, the Category III codes remain temporary, with provisional status on the Medicare Telehealth Services List through at least 2027. CMS continues to evaluate the evidence, and the push toward permanent Category I codes—the ones that would trigger consistent reimbursement across payers—is ongoing.

California has taken the lead at the state level, making Certified Wellness Coach services billable as a Medi-Cal benefit since January 2025 under the Children and Youth Behavioral Health Initiative. That’s a model other states could follow if the political will and the evidence base continue to grow.

The NBHWC, NCHEC, and UC San Diego collaborative project is actively collecting utilization data from coaches working in healthcare settings—data that will feed directly into the application for Category I codes. Every coaching session documented under the current Category III codes contributes to the evidence base that CMS is looking for.

I’m cautiously hopeful. The trajectory is moving in the right direction. The evidence is there. The coalition is well-organized and persistent. The question is whether the system—which moves slowly by design and is shaped by competing priorities and enormous financial pressures—will act on what the data is telling it.

Time will tell.

What coaches can do right now

If you’re an NBC-HWC or pursuing certification, there are practical things you can do to contribute to this momentum—even before reimbursement becomes standard.

Get your NPI number if you don’t have one already. You need a National Provider Identifier to bill for any healthcare services, and having one positions you for the moment the landscape shifts.

Document everything. If you’re working in a healthcare setting, use the Category III codes (0591T, 0592T, 0593T) to document your coaching sessions. The utilization data being collected right now is part of what will make the case for permanent codes. Your sessions count.

Stay informed. Follow NBHWC’s advocacy updates, read the public comments submitted to CMS, and understand how the Physician Fee Schedule process works. This isn’t abstract policy—it’s the framework that will determine whether your profession can scale.

Talk about it. Share what coaching does with your colleagues, your clients, and your networks. The more the broader healthcare community understands what we do—not in marketing terms, but in clinical, outcomes-driven terms—the stronger the case becomes.

A personal note

I became a health coach because I watched my mom fight a battle with cancer that I believe could have gone differently if someone had been in her corner sooner—not just prescribing, but listening, connecting dots, and helping her make changes before the damage was too far along.

I can’t go back in time and save myself sooner—or my mom—but I can continue my education and my advocacy in hopes that the system eventually catches up to what patients actually need.

This isn’t just about billing codes and fee schedules. It’s about a fundamental question: does the healthcare system value prevention, behavior change, and the human relationship between a coach and a patient? The evidence says it should. The economics say it should. The 28,000+ certified coaches doing this work every day say it should.

I hope the system is listening. And I hope this gives another coach, clinician, or self-healer some hope and direction.

As always, I hope these observations spark personal exploration and understanding—and maybe a little action.

Sources

  • American Medical Association. Health and Well-Being Coaching CPT Codes (Category III: 0591T, 0592T, 0593T), approved 2019, effective January 2020. ama-assn.org
  • Centers for Medicare & Medicaid Services. CY 2024 Physician Fee Schedule Final Rule: health coaching added to Medicare Telehealth Services List provisionally through 2027.
  • National Board for Health & Wellness Coaching. Certification and workforce data. nbhwc.org

Rance Edwards is a National Board Certified Health and Wellness Coach (NBC-HWC) with over 2,000 clinical hours of experience, specializing in chronic disease management and lifestyle medicine.

If you’re navigating chronic health issues and wondering whether a health coach could help, I offer a free discovery call with no pressure and no obligations. If we’re not the right fit, I’ll tell you—and I’ll do my best to point you toward someone who is. Book a Free Discovery Call

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