This is a moment worth celebrating for Nurse Coaching and the entire nursing profession!
On November 4, 2026, the Centers for Medicare & Medicaid Services (CMS) announced a significant development: Beginning January 1, 2027, Medicare will establish national payment rates for health and well-being coaching services.
Even more importantly for the nursing profession, CMS explicitly recognizes the American Holistic Nurses Credentialing Corporation (AHNCC) national standards for Certified Nurse Coaches as an acceptable credentialing pathway for qualified personnel providing these services.
This represents a meaningful step forward in recognizing the value of Nurse Coaching in supporting whole-person health, chronic disease prevention, and sustainable behavior change. So, can all Nurse Coaches bill Medicare? Under the new rule, Registered Nurses (RNs) cannot independently bill Medicare for these services. An eligible Medicare-enrolled practitioner, such as a physician or nurse practitioner, submits the claim while a qualified board-certified Nurse Coach provides the coaching under that practitioner’s general supervision. Here is what CMS decided and what it means for you.
For nurses who have long understood the importance of looking beyond symptoms and diagnoses to care for the whole person, this is an exciting milestone.
Jan 1, 2027
National Medicare payment for health and well-being coaching begins
$137.69
National office payment for the initial coaching assessment (0591T)
NC-BC and HWNC-BC
AHNCC Nurse Coach credentials CMS recognizes
General supervision
The billing practitioner does not need to be on site
Key Takeaways
- Beginning January 1, 2027, Medicare will pay nationally for health and well-being coaching (CPT codes 0591T, 0592T, and 0593T).
- AHNCC board-certified Nurse Coaches (NC-BC and HWNC-BC) are among the qualified professionals who can provide these services.
- Coaching can be provided under general supervision, so the billing practitioner does not need to be in the room.
- Sessions can take place by telehealth, with no monthly limit when they are reasonable and necessary.
- RNs do not bill Medicare directly. A physician or nurse practitioner submits the claim.
On this page
What Did CMS Finalize?
The 2027 Medicare Physician Fee Schedule includes several important developments for Nurse Coaching.
1. National Medicare Reimbursement for Coaching Begins January 1, 2027
CMS finalized national payment for three existing health and well-being coaching CPT codes:
- 0591T: Individual initial assessment (60 to 90 minutes)
- 0592T: Individual follow-up coaching session (at least 30 minutes)
- 0593T: Group coaching session (two or more individuals, at least 30 minutes)
Although these codes have existed since 2020, Medicare previously relied on contractor pricing rather than national payment rates. For background on these codes, see our guide to Nurse Coaching CPT codes.
This decision establishes a national Medicare payment framework for eligible health and well-being coaching services, creating new opportunities to integrate coaching into healthcare delivery.
2. CMS Increased Payment for Individual Coaching Sessions
CMS also listened when commenters said the proposed payment values were too low. In its July proposal, CMS valued the individual sessions by comparing them with shorter care management services. In the final rule, CMS agreed this did not reflect the time coaching takes and raised the values for both individual codes. Payment for group coaching stayed as proposed.
Here is what Medicare will pay nationally in 2027:
| Code | Coaching session | Work value (RVU): July proposal → final | National payment, office setting | National payment, facility setting |
|---|---|---|---|---|
| 0591T | Individual initial assessment, 60 to 90 minutes | 1.00 → 1.81 | $137.69 | $75.05 |
| 0592T | Individual follow-up, at least 30 minutes | 0.70 → 1.00 | $74.07 | $42.09 |
| 0593T | Group session, per person, at least 30 minutes | 0.23 → 0.23 (unchanged) | $22.51 | $9.79 |
These are national amounts before geographic adjustment, paid to the billing physician or nurse practitioner. Local amounts vary by region. Source: CMS, CY 2027 Medicare Physician Fee Schedule Final Rule, Addendum B (CY 2027 conversion factor $32.6286).
3. Certified Nurse Coaches Are Explicitly Recognized
One of the most meaningful developments for the nursing profession is CMS’s recognition of AHNCC Certified Nurse Coach standards.
The final rule specifically discusses Nurse Coach Board Certified (NC-BC) and Health and Wellness Nurse Coach Board Certified (HWNC-BC), retaining AHNCC standards as an acceptable credentialing pathway.
This recognition is especially significant because Nurse Coaching is not a separate profession. It is a specialized practice within professional nursing. The American Nurses Association describes this practice in The Art and Science of Nurse Coaching (2nd ed., 2021).
Nurse Coaching is not a separate profession. It is a specialized practice within professional nursing.
Through advanced education and board certification, Nurse Coaches build upon their nursing knowledge and skills to support individuals in exploring their health, identifying meaningful goals, and creating sustainable behavior change. To learn how to earn the NC-BC or HWNC-BC credentials, see our Nurse Coach certification guide.
What Makes Nurse Coaches Uniquely Qualified?
While CMS recognizes several qualifying health coaching credentials and training pathways, Nurse Coaches bring a distinct foundation to this work: they are licensed nurses who combine clinical knowledge, professional nursing judgment, and specialized Nurse Coaching education.
Unlike health coaching pathways that do not require a healthcare license, Nurse Coaching builds upon the education, experience, and scope of practice of a registered nurse.
Nurse Coaches understand the complexities of health and illness, recognize when additional clinical assessment or intervention may be needed, and collaborate with other healthcare professionals to support continuity of care.
Through a holistic, relationship-centered approach, Nurse Coaches partner with individuals to explore the physical, emotional, mental, social, and environmental influences on health while supporting meaningful, sustainable behavior change.
This combination of nursing expertise and coaching competencies uniquely positions Nurse Coaches to bridge the gap between clinical recommendations and the everyday changes that support long-term health and well-being.
To explore these distinctions further, read our article: Nurse Coach vs. Health Coach vs. Life Coach: What’s the Difference?
4. General Supervision Replaces the Proposed Direct Supervision Requirement
In its proposed rule, CMS initially called for direct supervision of health and well-being coaching services.
Following public comments from nurses, Nurse Coaches, nursing organizations including the Integrative Nurse Coach® Academy (INCA), and other stakeholders, CMS finalized general supervision instead of direct supervision.
What is the difference?
Direct supervision
Requires the supervising practitioner to be immediately available, in person or through real-time audio and video, while services are provided.
General supervision
Allows services to be furnished under the practitioner’s overall direction and control without requiring the practitioner to be physically present during each coaching session.
CMS defines both terms in its regulations: general supervision in 42 CFR 410.26 and direct supervision in 42 CFR 410.32.
This change is particularly important for Nurse Coaching because it creates greater flexibility to integrate Nurse Coaching into healthcare organizations and community settings.
Importantly, this rule does not establish independent Medicare billing privileges for RNs. Eligible services furnished by qualified Nurse Coaches may be billed by a supervising Medicare practitioner under applicable incident-to requirements.
How it works under the final rule:
1
The Nurse Coach coaches
A qualified Nurse Coach (NC-BC or HWNC-BC) provides the health and well-being coaching session, in person or by telehealth.
2
The practitioner supervises
A physician or nurse practitioner provides general supervision. They do not need to be on site during the session.
3
The practitioner bills Medicare
The physician or nurse practitioner submits the claim using CPT codes 0591T, 0592T, or 0593T.
5. Telehealth Remains an Option
CMS confirmed that health and well-being coaching services remain on the Medicare Telehealth Services List.
This creates opportunities to expand access to coaching for individuals with geographic, transportation, mobility, or other barriers to in-person care.
All services remain subject to Medicare telehealth and billing requirements.
6. No Monthly Frequency Limit
CMS did not establish a monthly frequency cap for these coaching codes.
Multiple coaching sessions may be billed within the same month when reasonable and necessary.
This is particularly meaningful for Nurse Coaching, where ongoing partnerships, accountability, and individualized support are central to helping individuals create sustainable changes in their health and well-being.
What Does This Mean for Patient Care?
At the heart of this milestone is an opportunity to expand access to whole-person, person-centered care.
Patients often leave healthcare appointments knowing what changes are recommended but may need additional support to integrate those recommendations into their daily lives.
Nurse Coaching helps bridge the gap between knowing what to do and discovering how to make meaningful, sustainable changes.
Through ongoing coaching partnerships, patients have opportunities to:
- Feel heard and understood: Experience a relationship-centered approach that honors their individual needs, values, and experiences.
- Take an active role in their health: Identify meaningful goals and discover their own strengths and capacity for change.
- Build sustainable habits: Explore realistic approaches to nutrition, movement, sleep, stress management, and other lifestyle factors.
- Receive ongoing support and accountability: Reflect on progress, navigate challenges, and adjust goals as their needs evolve.
- Strengthen connections with their healthcare team: Receive coaching support that complements clinical treatment and encourages active participation in their care.
For individuals managing chronic conditions, these ongoing partnerships may be especially valuable in supporting self-management, health promotion, and long-term well-being.
With Medicare establishing a national payment framework, more patients may have opportunities to access the personalized support Nurse Coaching provides.
This represents an important step toward healthcare that not only addresses illness but also supports individuals in creating healthier lives.
What Does This Mean for Physicians, Nurse Practitioners, and Other Healthcare Practitioners?
The CMS decision also creates new opportunities for physicians, nurse practitioners, and other healthcare professionals to integrate Nurse Coaching into their care delivery models.
Healthcare practitioners frequently provide essential clinical recommendations related to managing chronic conditions, improving lifestyle habits, and preventing disease. However, meaningful behavior change often requires ongoing conversations, individualized support, and accountability beyond the traditional clinical appointment.
Nurse Coaches can complement the work of physicians and other healthcare practitioners by helping patients translate clinical recommendations into sustainable daily practices.
Integrating qualified Nurse Coaches into healthcare teams may offer several benefits:
- Enhanced patient engagement: Nurse Coaches partner with patients to identify personal goals, explore barriers, and actively participate in their health.
- Greater continuity of care: Ongoing coaching relationships can reinforce clinical recommendations and support patients between medical appointments.
- Expanded team-based care: Nurse Coaches bring nursing knowledge and specialized coaching competencies to interdisciplinary collaboration.
- Support for chronic disease management: Coaching can help patients explore sustainable changes in nutrition, physical activity, sleep, stress, and other factors that influence health.
- New reimbursement opportunities: Eligible Medicare practitioners and healthcare organizations may incorporate qualified Nurse Coaches into their care models and bill for covered health and well-being coaching services under applicable Medicare requirements.
Because CMS finalized general supervision, the billing practitioner does not need to be on-site during coaching sessions, which may make it more feasible for medical practices and healthcare organizations to incorporate Nurse Coaching into existing workflows.
Nurse Coaches do not replace physicians or other healthcare practitioners. Instead, they contribute complementary nursing expertise and relationship-centered coaching that supports a more comprehensive approach to patient care.
By working collaboratively, Nurse Coaches and healthcare practitioners can create opportunities for care that addresses both clinical needs and the sustainable behavior changes that support long-term health.
A Note for Nurse Practitioners
Nurse practitioners can bill Medicare for these coaching services and can supervise Nurse Coaches on their team. An NP who also holds NC-BC or HWNC-BC brings both pieces together: the practitioner who can bill for the service and the Nurse Coach credential CMS recognizes. Because billing arrangements vary, it is wise to review the details with your billing and compliance team.
Nurses who want to help bring Nurse Coaching into their organization can learn how in our course, Integrating Nurse Coaching into Organizations and Communities.
What Does This Mean for the Nursing Profession?
For decades, nurses have recognized that health involves more than diagnosing and treating disease.
Nursing considers the whole person, including physical, emotional, mental, social, and environmental influences on health.
Nurse Coaching builds upon this foundation through relationship-centered partnerships, compassionate inquiry, presence, and evidence-informed approaches that support individuals in discovering their own strengths and capacity for change.
Rather than simply telling individuals what they should do, Nurse Coaches partner with them to explore what matters most, identify meaningful goals, and develop sustainable approaches to health and well-being.
The CMS decision creates an important opportunity to integrate this approach more widely into healthcare delivery.
For nurses who are seeking new ways to practice, reconnect with their passion for nursing, or expand their professional contributions, Nurse Coaching offers a pathway to bring the art and science of nursing together.
New Possibilities for Nurses Interested in Nurse Coaching
An RN who completes specialized Nurse Coaching education and earns AHNCC Nurse Coach Board Certification may meet an accepted credentialing pathway for providing eligible health and well-being coaching services under Medicare.
For example, a nurse could:
- Complete the Integrative Nurse Coach® Certificate Program (INCCP).
- Meet eligibility requirements and earn AHNCC Nurse Coach board certification (NC-BC, or HWNC-BC for nurses also certified in holistic nursing).
- Work with an eligible Medicare billing practitioner or healthcare organization.
- Provide qualifying health and well-being coaching services under general supervision.
- Have eligible services billed by the Medicare practitioner under applicable requirements.
This does not mean every Nurse Coach can independently bill Medicare or that all Nurse Coaching services automatically qualify for reimbursement.
However, it represents a meaningful opportunity for healthcare organizations to explore how qualified Nurse Coaches can contribute to patient care within an established reimbursement framework.
What This Rule Does Not Do
It is important to be clear about the limits of this decision:
- It does not allow RNs to bill Medicare directly. A physician or nurse practitioner submits the claim.
- It does not certify anyone. Nurse Coaching education prepares nurses for board certification, and CMS recognizes the AHNCC credential.
- It does not change scope of practice. What a nurse may do is still guided by their state’s Nurse Practice Act.
- It applies to Medicare. That includes Medicare Advantage plans, which must cover the services Original Medicare covers. Commercial insurers and state Medicaid programs make their own decisions. Many base their payment rates on Medicare’s, but there is no set timeline for when they add coverage for new codes.
The Power of Advocacy: Nurses Helping Shape Healthcare Policy
This milestone also demonstrates the importance of nurses participating in decisions that shape healthcare policy.
During the public comment period, nurses, Nurse Coaches, nursing organizations, and other stakeholders advocated for recognition of Nurse Coach qualifications and a supervision model that supports the realities of nursing practice.
CMS responded by retaining AHNCC Certified Nurse Coach standards as an accepted credentialing pathway and replacing the proposed direct supervision requirement with general supervision.
Not every request was adopted. Nursing organizations, including INCA, also asked CMS to remove the supervision requirement for licensed nurses and allow nurses to bill directly. CMS did not make that change, and we will continue to advocate for policies that reflect the scope of the nursing license. You can read INCA’s comment to CMS.
These decisions reflect the importance of bringing nursing perspectives into healthcare policy discussions.
We extend our gratitude to the organizations and individual nurses who contributed their voices to this collective effort.
When nurses advocate for their profession, they help shape possibilities for the future of healthcare.
Looking Ahead: The Future of Nurse Coaching
The 2027 Medicare Physician Fee Schedule represents more than a new reimbursement opportunity.
It reflects growing recognition of the value of health and well-being coaching in supporting individuals to make meaningful, sustainable changes. It also brings greater attention to prevention, patient engagement, and long-term well-being across healthcare.
At the Integrative Nurse Coach® Academy (INCA), we have long been committed to advancing Nurse Coaching education and supporting nurses in expanding the possibilities within their professional practice.
We believe Nurse Coaching offers an important pathway for nurses to reconnect with the heart of nursing while contributing to whole-person, relationship-centered care.
As CMS releases implementation guidance, we look forward to sharing additional information about what this development means for nurses and healthcare organizations.
This is a milestone worth celebrating, not only for Nurse Coaches, but for the entire nursing profession.
We invite you to share this news with your nursing colleagues, healthcare leaders, and professional communities.
Together, we can continue expanding awareness of Nurse Coaching and the possibilities it creates for nursing practice and whole-person health.
Frequently Asked Questions
When does Medicare begin paying for health and well-being coaching?
National Medicare payment begins January 1, 2027, under the CY 2027 Medicare Physician Fee Schedule final rule CMS released on November 4, 2026.
Can Nurse Coaches bill Medicare or insurance?
Not directly. RNs, including Nurse Coaches, do not bill Medicare themselves. A physician or nurse practitioner submits the claim, and a qualified Nurse Coach provides the coaching under that practitioner’s general supervision. Commercial insurers make their own decisions about coaching, so coverage outside Medicare varies by plan.
Which credentials qualify someone to provide these services?
CMS names three national standards: the American Holistic Nurses Credentialing Corporation standards for Certified Nurse Coaches (NC-BC and HWNC-BC), the National Board for Health and Wellness Coaching, and the Certified Health Education Specialist credential. Training through certain evidence-based programs overseen by the Administration for Community Living also qualifies.
Can coaching sessions be provided by telehealth?
Yes. The coaching codes are on the Medicare Telehealth Services List. Medicare telehealth and billing requirements still apply.
How can a nurse become eligible for Nurse Coach board certification?
Nurses complete Nurse Coach education and supervised coaching hours that meet AHNCC requirements, then sit for the AHNCC exam. Graduates of the Integrative Nurse Coach® Certificate Program are eligible to sit for the NC-BC exam. Learn more about Nurse Coach board certification.
Sources and Additional Resources
- CMS Final Rule: CY 2027 Medicare Physician Fee Schedule Final Rule (CMS-1848-F), Section II.D, item (56): Health Coaching (CPT Codes 0591T, 0592T, and 0593T). Displayed November 4, 2026; effective January 1, 2027.
- Federal Register: Document 2026-22743 (publishes November 9, 2026)
- Payment amounts: CY 2027 Medicare Physician Fee Schedule Final Rule, Addendum B
- Supervision definitions: 42 CFR 410.26 (general supervision) and 42 CFR 410.32 (direct supervision)
- Nurse Coaching standards: American Nurses Association, The Art and Science of Nurse Coaching, 2nd ed. (2021)
- INCA Resource: Nurse Coach vs. Health Coach vs. Life Coach: What’s the Difference?
- INCA Resource: Nurse Coaching CPT Codes
- INCA Resource: INCA’s Comment to CMS on Nurse Coaching Coverage
- INCA Resource: Nurse Coach Certification Guide
Ready to become a Nurse Coach?
The Integrative Nurse Coach® Certificate Program has prepared nurses for this role for more than fifteen years. Self-paced within a cohort, 294+ ANCC contact hours, mentorship twice a month, and graduates who are board-certification eligible for NC-BC and HN-BC.
Karly Mertz
Karly Mertz, MSN, RN, NC-BC is a Board-Certified Nurse Coach and serves as Nurse Planner and Program Coordinator at the Integrative Nurse Coach® Academy. She holds a Master of Science in Advanced Holistic Nursing from Florida Atlantic University. With over a decade of experience as a surgical and cardiac nurse, Karly brings a grounded clinical background to her holistic practice. After completing the Integrative Nurse Coach® Certificate Program through INCA, she fully embraced her calling to support healing through a whole-person, heart-centered lens. Karly has led group Nurse Coaching sessions for pregnant and postpartum mothers in her community, incorporating holistic modalities such as guided meditation, journaling, EFT tapping, and sound healing.
Ronald Kanka
Ronald D. Kanka is the Chief Operating Officer of the International Nurse Coach Association and Integrative Nurse Coach® Academy (INCA), where he leads strategic growth, operational excellence, and innovation across the organization’s global programs.
With a background at the University of Miami Miller School of Medicine’s Integrative Medicine Division, Ronald built his foundation in healthcare education by managing large-scale continuing education initiatives in clinical nutrition, acupuncture, and complementary therapies. His work focused on creating high-impact learning experiences that brought together clinicians, educators, and thought leaders in integrative health.
In 2012, Ronald met INCA co-founder Susan Luck at a clinical nutrition conference—an encounter that would shape the trajectory of his career. He began working with INCA as a Program Manager and quickly became a driving force behind the organization’s expansion and evolution. Recognized for his strategic vision and operational leadership, he played a central role in transforming the Integrative Nurse Coach® Certificate Program from an in-person offering into a scalable, global online program—helping position INCA at the forefront of the nurse coaching movement.
As COO, Ronald oversees organizational strategy, program development, admissions and marketing systems, and operational infrastructure. His work has been instrumental in expanding INCA’s reach, strengthening its educational model, and supporting thousands of nurses worldwide in integrating holistic, mind-body-spirit approaches into their practice.
Ronald is deeply committed to advancing the future of nursing through innovation, systems thinking, and a more human-centered approach to care. His leadership continues to shape INCA’s role as a pioneer in bridging evidence-based practice with integrative and holistic health.
