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9 questions to discuss with counsel before signing a health coaching services agreement
Coaches and practices are drafting contracts for 2027 Medicare coaching. These are the topics to raise with healthcare counsel before anyone signs.
As practices plan for national Medicare payment of health coaching codes 0591T–0593T in 2027, many will bring in coaches by contract or through community-based organizations rather than hiring them. The final rule doesn't describe these arrangements, so the contract carries a lot of weight.
This post is not legal advice. It's a list of topics to raise with a qualified healthcare attorney. Bring it to that conversation.
The questions
- Who is the supervising practitioner, and how is supervision documented? Under 42 CFR 410.26(b)(5), coaching is incident-to under general supervision, and only the supervising practitioner bills.
- Is the arrangement structured so incident-to billing is appropriate? Counsel will look at the relationship between the coach, any CBO, and the billing practitioner, including any reassignment questions.
- Who owns the documentation and medical record? The practice needs the notes to support its claims; the coach needs access to do the work.
- How are qualifications verified and maintained? Credential pathway, coaching training, OIG exclusion screening, and what happens if a credential lapses.
- How is the coach paid? Compensation tied to referrals or Medicare volume raises Anti-Kickback Statute questions. Have counsel review the structure.
- What does the BAA cover? Coaches handle protected health information; the HIPAA business associate terms should match the actual data flow.
- Who carries liability and insurance? Professional liability coverage for the coach, and indemnification terms.
- What happens with clinical issues? The contract should require referral to the practitioner and define the escalation path.
- How are audits and refunds handled? If a claim is denied or recouped, what does each party owe, and who cooperates with reviews?
Starting points, not finished contracts
The toolkit includes a services-agreement template clearly marked "attorney review required." It's meant to organize this conversation, not replace it. For how the roles divide day to day, see adding coaching to a practice and working with a Medicare practice as a coach.
Educational only; not legal, billing, coding or clinical advice. Your supervising practitioner's and organization's policies come first, and they must comply with CMS, your MAC and state law. CPT® is a registered trademark of the American Medical Association.