Nurse Coaching CPT Codes
August 2026 update
CMS has proposed national Medicare payment for health and well-being coaching under CPT codes 0591T, 0592T, and 0593T, and has named the AHNCC board certification standards for Certified Nurse Coaches among the credentials it will accept. Public comment is open through September 14, 2026.
Current status, August 2026. The coaching codes are Category III. Medicare payment is proposed but not final. The CY 2027 Physician Fee Schedule final rule is expected in the fall.
How Nurse Coaches were added to the Health and Well-Being Coaching CPT codes
In 2021, the American Medical Association approved a modification to the Current Procedural Terminology (CPT®) codes for Health and Well-Being Coaching to include Board Certified Nurse Coaches (NC-BC).
That change did not happen on its own. Karen Avino, EdD, RN, AHN-BC, HWNC-BC, SGAHN, Chief Executive Officer of the Integrative Nurse Coach® Academy, worked alongside the American Holistic Nurses Association and the American Holistic Nurses Credentialing Corporation to bring the request forward and secure approval.
When the AMA CPT Editorial Panel first created these codes in 2019, following an application from the Veterans Health Administration, the definition of Health and Well-Being Coaching did not include Certified Nurse Coaches. The 2021 modification corrected that omission. It is the reason Nurse Coaches appear in the federal conversation about coaching payment today.
“Nurses are leading the way in lifestyle health and wellbeing coaching due to our extensive nursing education, training, and healthcare experience that we bring to the nurse-patient relationship. The core of nursing practice is health promotion, and we can lead healthcare transformation to move from a disease and symptom management focus to a wellness and holistic approach to care. Nursing has its own practice, and it is time for each nurse to reenergize their practice with new communication techniques and coaching skills to create behavior change, engagement, and responsibility for self-care in patients. This will make a difference in the chronic disease epidemic and the suffering experienced on a local to global scale.”
Karen Avino, EdD, RN, AHN-BC, HWNC-BC, SGAHN
The Health and Well-Being Coaching CPT codes
| Code | Description |
| 0591T | Health and well-being coaching face-to-face; individual, initial assessment, 60 to 90 minutes |
| 0592T | Individual, follow-up session, at least 30 minutes |
| 0593T | Group (two or more individuals), at least 30 minutes |
The codes were published to the AMA CPT® website in January 2022 and took effect July 1, 2022.
Category I and Category III: what the difference means
CPT codes are grouped into categories that signal how established a service is.
Category I codes describe services with demonstrated clinical efficacy, published evidence, and widespread use. These are the familiar five-digit codes payers reimburse as a matter of course.
Category III codes are temporary codes for emerging services. They end in the letter T. Their purpose is to make a service visible in the data so that use and outcomes can be tracked while the evidence base develops. Payment for Category III codes has historically been discretionary rather than automatic.
The health and well-being coaching codes are Category III. Until now, that has meant Medicare payment was contractor-priced: each Medicare Administrative Contractor decided locally whether to pay and at what rate. Coverage varied by region and was difficult to predict.
Two separate decisions, often confused
A point worth being precise about, because it is widely misunderstood: the category of a code and the payment for a code are decided by two different organizations.
The American Medical Association, through its CPT Editorial Panel, owns the code set and decides what is Category I and what is Category III.
The Centers for Medicare & Medicaid Services decides what Medicare pays for and how much.
Neither controls the other. CMS can pay for a Category III code without the AMA changing anything, and the AMA can promote a code to Category I without Medicare choosing to pay for it.
|
|
The CY 2027 proposed rule moves Medicare payment from contractor pricing to national pricing. It does not change the codes from Category III to Category I, which is a separate decision belonging to the AMA.
What the CY 2027 CMS proposal would actually do
The proposed rule would change how Medicare pays for these codes. It would not change their category.
CMS has proposed national payment and valuation for all three codes, setting a single payment amount in the Physician Fee Schedule rather than leaving pricing to individual contractors. The agency proposed work relative value units of 1.00 for 0591T, 0.70 for 0592T, and 0.23 for 0593T, valuing them by reference to chronic care management services.
Nationally pricing a Category III code is not routine. Provisional codes are usually left contractor-priced precisely because they are provisional. CMS proposing to price these consistently across the country reflects a judgment that the service has moved beyond the experimental stage.
For a nurse in practice, national pricing may matter more in the near term than a category change would. A single national rate is what makes a service reliably schedulable, consistently billable, and worth an employer’s investment to staff.
Two things the proposal does not do:
- It does not convert these to Category I codes. That decision belongs to the AMA CPT Editorial Panel, not to CMS.
- It does not allow a Nurse Coach to bill Medicare independently. Registered Nurses do not enroll as Medicare Part B suppliers. Under the proposal, a practitioner bills for the service.
What it would establish is that Medicare pays for health and well-being coaching nationally, and that the AHNCC credential is recognized among those qualified to deliver it.
What happens next
Comments close September 14, 2026. CMS reviews every comment submitted to the docket. Comments arriving after the deadline are not considered.
CMS responds in the final rule. The agency addresses significant comments it receives, which is why the substance of what nurses write matters more than the volume. The Physician Fee Schedule final rule is typically issued in the fall.
Policies take effect January 1, 2027. Whatever CMS finalizes, including payment amounts and the conditions of payment, would apply to services provided on or after that date.
What could change between now and then. CMS may finalize the proposal as written, modify the supervision condition, adjust the valuations, or decline to finalize national payment. It has also asked whether to create HCPCS G-codes for these services instead, which would be addressed in the same rule.
We will update this page when the final rule publishes.
The path from Category III to Category I
Category III codes are typically reviewed after about five years. They may be converted to Category I, extended, or allowed to expire. Conversion requires the AMA CPT Editorial Panel to find sufficient published literature and demonstrated widespread use.
Utilization data is what builds that case. This is why consistent use of 0591T, 0592T, and 0593T has mattered since 2022 even where payment was uncertain. Every documented session contributes to the record that a future conversion request would rest on.
National Medicare pricing helps here too, though indirectly. Payment drives use, use generates data, and data is what the AMA panel needs to see.
CMS has separately asked whether it should create HCPCS G-codes to describe these services for CY 2027. G-codes are a Medicare-specific coding system rather than a step toward Category I, and INCA’s comment addresses how any such codes should be structured.
Timeline: Nurse Coaching and the coaching CPT codes
2019
The AMA CPT Editorial Panel accepts three new Category III codes for Health and Well-Being Coaching, following an application from the Veterans Health Administration. The definition does not include Certified Nurse Coaches.
2021
INCA, working with AHNA and AHNCC, secures an AMA modification adding Board Certified Nurse Coaches to the definition.
2022
The codes are published to the AMA CPT® website and take effect July 1.
2024
CMS adds 0591T, 0592T, and 0593T to the Medicare Telehealth Services List in the CY 2024 Physician Fee Schedule final rule.
2026
CMS proposes national payment for all three codes, replacing contractor pricing, and names the AHNCC standards for Certified Nurse Coaches among accepted certifications. Public comment is open through September 14.
What INCA is working toward now
The current proposal contains one condition that would limit its effect. As written, these services could only be provided under the direct supervision of a billing practitioner, with everyone furnishing them treated as auxiliary personnel.
That framework is reasonable for a coach whose only preparation is a certificate. It does not fit a Registered Nurse or Advanced Practice Registered Nurse.
Why we are asking CMS to change it:
Nurses are licensed. Health promotion, patient education, and behavior change counseling are already independent functions of nursing practice under every state nurse practice act. No state requires supervision for a Registered Nurse to provide them. A supervision condition places a payment rule above state licensure law.
Board certification adds a second layer. AHNCC board certification requires an active unrestricted license, documented practice experience, dedicated Nurse Coach education, supervised practice hours, and a national examination. It is inconsistent to accept that credential as evidence of competency while requiring the certified nurse to be supervised.
The proposal is inconsistent with its own valuation. CMS priced these codes by reference to chronic care management services, which it describes as being performed under general supervision, then proposed direct supervision as the condition of payment.
Employment setting would outweigh licensure. The same rule would permit coaches employed by community-based organizations to work under general supervision. A board-certified nurse in a clinic would not receive that flexibility.
It creates barriers without adding safety. A supervision requirement ties every session to a second professional’s availability. It does not make the service safer when the person delivering it is already a licensed clinician who recognizes warning signs, understands comorbidities and medications, and escalates concerns appropriately.
INCA has submitted comments to CMS on these points and has published templates so that individual nurses, nursing organizations, and employers can do the same.
Next steps
1. Submit a comment to CMS before September 14, 2026. This is the single most useful thing a Nurse Coach can do right now. CMS expressly asked for comment on the certification standards and the conditions of payment, which means the question is genuinely open. Templates and filing instructions are here, and comments are filed at regulations.gov under file code CMS-1848-P.
2. Write in your own words. CMS discourages duplicative comments. The passage reviewers read most closely is a short account of one patient whose health changed through your coaching, with every identifying detail removed. No template can supply that.
3. Share it with colleagues and your employer. Volume of distinct comments is what an agency registers. Nursing organizations and employers can file their own letters, and those carry weight individual comments cannot. Employers who support this work may also be interested in employer reimbursement for continuing education.
4. Document your coaching consistently. Whatever CMS finalizes, the utilization record built through 0591T, 0592T, and 0593T is what supports the eventual case for Category I conversion.
5. Watch for the final rule. CMS typically issues the Physician Fee Schedule final rule in the fall, with policies effective the following January. We will update this page when it publishes.
6. Prepare your practice. Nurses who understand the coding, documentation, and scope questions now will be positioned to act when payment policy settles. Our Integrative Nurse Coach® Certificate Program covers Nurse Coaching practice, documentation, and professional implementation.
Why nursing belongs in this conversation
Nursing has been rated the most trusted profession in the United States for more than two decades in Gallup’s annual survey. Nurses who practice with a holistic approach create the conditions in which patients find the internal motivation and confidence to change their health behaviors.
Health promotion, patient education, and behavior change counseling are already core to nursing practice. That existing scope, combined with clinical judgment and an underlying license, is what distinguishes a Nurse Coach from a coach whose only preparation is a certificate. The difference is explained further in our comparison of Nurse Coaching, health coaching, and life coaching.
Research and program partnerships
If you work with a specific patient population and have ideas or support for research using these codes, we would like to hear from you. Contact us at admissions@inursecoach.com. You can also review our Integrative Health and Wellness Assessment research.
About the Integrative Nurse Coach® Academy
INCA has been setting the standard in Nurse Coach education for more than fifteen years, working with health systems to integrate holistic and Nurse Coaching practice through consultation, program delivery, and train-the-trainer programs. Organizations interested in this work can read about integrating Nurse Coaching into an organization.
The Integrative Nurse Coach® Certificate Program prepares Registered Nurses and Advanced Practice Registered Nurses for Nurse Coaching practice, health and wellbeing promotion, lifestyle health change, and holistic interventions, with over 300 contact hours of accredited nursing continuing professional development.
INCA founders Barbara Dossey and Susan Luck pioneered the INCCP curriculum, authored the foundational textbook on Nurse Coaching, and led the development of Nurse Coach competencies and scope of practice. Their work is collected in the Nurse Coaching textbook. The organization is led by Chief Executive Officer Karen Avino, EdD, RN, AHN-BC, HWNC-BC, SGAHN, and Chief Operating Officer Ronald D. Kanka.
Comments to CMS close September 14, 2026.
CMS asked for public comment on the certification standards and the conditions of payment. The question is open until then.