Chapter 1 Purpose & Scope
The field manual for documenting Medicare health coaching.
Code-mapped SOAP templates, a supervision log, and a plain-English guide to 0591T, 0592T and 0593T under the CY 2027 Final Rule. Built for CHES®, MCHES® and health coaches, and for the practices that supervise them.
1-1. Who this manual is for
- Health education specialists CHES® and MCHES® professionals moving into clinical coaching.
- Health & wellness coaches NBC-HWCs and nurse coaches working with Medicare patients.
- Practice managers & clinicians The practices that supervise coaching and submit the claims.
- Community-based organizations CBO staff furnishing coaching under general supervision.
Chapter 2 Change 1: CY 2027 Final Rule
What the final rule changed
| Code | Service (paraphrased) | Time per CPT descriptor | Final work RVU | Approx. national payment* |
|---|---|---|---|---|
| 0591T | Individual, initial assessment | 60–90 min | 1.81 | $137.69 |
| 0592T | Individual, follow-up session | At least 30 min | 1.00 | $74.07 |
| 0593T | Group (2+ individuals), billed per beneficiary | At least 30 min | 0.23 | $22.51 |
*Estimated national, unadjusted, non-facility amounts calculated from CMS Addendum B RVUs and the rule's estimated conversion factor (32.6286). They are not published by CMS. Local amounts vary by locality and setting; confirm with your MAC.
2-1. National pricing
CMS kept the existing Category III codes and set national payment for them, effective January 1, 2027. Before this rule, payment was left to each contractor.
2-2. Incident-to, under general supervision
Coaching is furnished by auxiliary personnel incident to a physician's or practitioner's services under general supervision, not the direct supervision CMS first proposed. Only the supervising practitioner may bill (42 CFR 410.26(b)(5)).
2-3. Who may furnish the service
Auxiliary personnel with appropriate certification. CMS lists pathways that "include, but are not limited to":
- National Board for Health & Wellness Coaching national standards
- National Commission for Health Education Credentialing eligibility for Certified Health Education Specialists
- American Holistic Nurses Credentialing Corporation standards for Certified Nurse Coaches
- Training from Older Americans Act evidence-based health-promotion programs
2-4. Other provisions
- No set frequency limits, as long as services are reasonable and necessary.
- The codes remain on the Medicare Telehealth Services List.
- Personnel employed by or affiliated with community-based organizations may furnish the service under general supervision.
- Coaching is not a billable RHC or FQHC visit.
Warning
CHES®, MCHES®, NBC-HWC and other coaches are not independent Medicare billers. The service is billed by the eligible supervising practitioner.
Caution: open items
- Medicare Administrative Contractor (MAC) guidance for these codes has not been published yet.
- CMS lists 0592T with an add-on ("ZZZ") indicator. How standalone follow-ups will process is unresolved.
- CPT language references completion of a health & well-being coaching training program. Keep evidence of coaching-specific training in your credential file.
Source: CMS-1848-F, CY 2027 PFS Final Rule (display copy and Addendum B), reviewed Nov 5, 2026.
Chapter 3 Contents
What's inside the toolkit
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3-1
Code-mapped SOAP templates
Fill-in templates (DOCX + fillable PDF) for the 0591T initial assessment, 0592T follow-up, and 0593T group session, with an individualized per-beneficiary note and roster.
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3-2
Practitioner order & plan of care
A template for the supervising practitioner to document the diagnosis, coaching goals, and frequency guidance that the coaching carries out.
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3-3
Supervision log & credential file
A general-supervision log plus a checklist for certification status, coaching-specific training, and exclusion screening.
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3-4
Billing & compliance cheat sheet
One page, front and back: who furnishes vs. who bills, time thresholds, same-day exclusion pairs, telehealth notes, ABN basics, and red flags.
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3-5
Patient-facing worksheets
Readiness-to-change ruler, SMART-goal contract, values worksheet, and a coaching consent form with a cost-sharing notice.
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3-6
Practice integration kit & video
A clinic pitch deck, ROI calculator, coach job description and contractor-agreement template (attorney review required), plus a 45–60 minute walkthrough from referral to compliant note.
Chapter 4 Procedure
From referral to a defensible note
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Practitioner evaluates and orders
The supervising practitioner documents the condition, the plan of care, and a coaching order with goals.
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Verify the credential file
Confirm certification status, coaching-specific training, and exclusion screening before the first session.
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Initial assessment: 0591T
Record start and stop times, modality, goals, and the link to the practitioner's plan.
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Follow-ups and groups: 0592T / 0593T
Document progress for each patient individually. Group notes are never cloned.
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Supervise, review and refer back
Log periodic review by the practitioner. Any new clinical issue goes back to the practitioner, because the coach does not triage.
Note
The rule's coaching section does not list documentation elements. This procedure follows general incident-to and time-based documentation practice. Your supervising practitioner's and organization's policies come first; confirm local requirements with your MAC.
Annex A Veteran Care
Coaching veterans: a medic's field notes
Many Medicare patients are veterans, and most are seen in civilian practices. This module teaches civilian coaches the cultural context a medic learns in the field.
- Military culture primer: rank, unit identity, deployment cycles and transition stress
- Mapping coaching goals to the VA Whole Health "Circle of Health"
- A non-diagnostic veteran intake add-on: screen and refer, never diagnose
- Safety protocol on every handout: Veterans Crisis Line, dial 988 then press 1
Coaching for Medicare-eligible veterans in community practice is billed to Medicare under these codes. The VA Community Care Network is not a payment pathway for this service. Not affiliated with or endorsed by the VA.
Chapter 5 Author
Written by a health educator and former medic
Chapter 6 Questions
Frequently asked questions
Can I bill Medicare myself as a CHES® or MCHES®?
No. Under the final rule, coaching is furnished by qualified auxiliary personnel under general supervision, and only the supervising practitioner bills. The toolkit shows how to document your part so the practitioner's claim is supported.
Does CMS name the MCHES® credential?
The final rule names "National Commission for Health Education Credentialing eligibility for Certified Health Education Specialists" as one certification pathway. MCHES® is not named separately. How your credential is treated is decided by your supervising practitioner and organization, consistent with CMS and your MAC. The credential-file checklist helps you document it.
Does buying the toolkit guarantee payment or eligibility?
No. It is an educational resource. It does not guarantee eligibility, credentialing, payment or reimbursement.
I manage a practice. Is this for me?
Yes. The practitioner order and plan-of-care template, supervision log, and practice integration kit are built for the practice that supervises and bills.
How current is the content?
It reflects the CY 2027 Final Rule released November 4, 2026. Every download carries a "Last verified" date. MAC guidance has not been published yet; check it before billing.
Do you offer continuing education credit?
Not at this time.
Chapter 7 Get the Toolkit
Document coaching with confidence from day one of 2027.
One payment of $197 gets you every template, the cheat sheet, the video walkthrough, and Annex A.