Unlock Insurance Reimbursement: A Guide to CPT & ICD-10 Codes for Medical Exercise Professionals

Good morning! Michael Jones from the Medical Exercise Training Institute here, and welcome to a crucial discussion for all medical exercise professionals looking to expand their practices and connect with the medical community: CPT and ICD-10 codes.

For years, the idea of insurance reimbursement for medical exercise professionals seemed like a distant dream. However, I'm happy to say that we are increasingly seeing medical exercise professionals successfully navigate the world of insurance carriers and receive reimbursement for their valuable services, especially over the last decade.

This brings us to the core of our discussion: understanding ICD-10 codes, the diagnostic codes, and CPT codes, the current procedural terminology codes, which are essential when dealing with insurance carriers. But let me be absolutely clear: simply knowing a CPT code is not the answer. There is a systemati...

Are you a Medical Exercise Professional (MedExPRO) who finds insurance billing overwhelming or confusing? Understanding CPT (Current Procedural Terminology) and ICD-10 (International Classification of Diseases, 10th Revision) codes is critical to your success and profitability as a medical exercise specialist.

In our upcoming Cracking the Code Webinar on Friday, April 18th at Noon ET, we'll simplify these essential coding systems—providing exactly what you need to know to streamline your billing and reimbursement process. Register now at www.crackingthecode.net.

Why CPT & ICD-10 Coding Matters for MedExPROs

CPT codes describe the specific services you provide as a medical exercise professional, while ICD-10 codes define your client's medical diagnoses or conditions. Correct coding ensures you receive accurate and timely reimbursement from insurance companies, creating a sustainable and profitable practice.

Key Concepts in CPT Coding for MET

• Selecting Accurate CPT Codes: Learn ho
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Let’s be honest—traditional personal training has its limits.

Sure, helping clients lose weight or gain muscle is rewarding. But what about the client who just completed physical therapy after a joint replacement? The one with chronic low back pain? Or the client managing diabetes, hypertension, or stroke recovery?

They don’t need a workout—they need a Medical Exercise Specialist!!

They need you—with the right training.

The Rise of Medical Exercise Training

The demand for post-rehab and medically-guided exercise is exploding. Millions of adults are completing physical therapy but still need structured, supervised movement to regain full function. Doctors, physical therapists, and chiropractors are actively seeking qualified fitness professionals they can trust to continue their patients’ care.

This is where Medical Exercise Training (MET) steps in.

As a Medical Exercise Specialist, you become the bridge between healthcare and fitness—helping clients transition safely from rehab ...

Medical Exercise Training (MET) is more critical than ever, bridging the gap between healthcare and fitness to help individuals manage medical conditions through structured exercise programs. As a Medical Exercise Professional (MedExPRO), your work positively impacts your clients' health and quality of life. However, achieving sustained success in this specialized field requires careful navigation.

To help you thrive, here are five common pitfalls every MedExPRO must avoid:

1. Ignoring the Business Side of Your Practice

Passion for client care alone is not enough. To run a successful MET practice, you must also master fundamental business principles. Neglecting essential management systems—such as scheduling, documentation, billing, and marketing—creates chaos and financial instability. Without clearly defined systems and regular tracking of your practice metrics (client retention, acquisition rates, profitability), you risk losing control of your business.

What to do instead:

• E...

Becoming a successful Medical Exercise Specialist (MES) is about more than your clinical skills—it’s about adopting the right mindsets and embracing specific practices that elevate your role from practitioner to business owner and trusted medical partner. Based on decades of experience and proven success, here are five essential mindset shifts that every MES needs to develop to build a thriving, impactful Medical Exercise Training (MET) practice:

1. Think Like a Business Owner

Your passion for helping clients improve their function is critical—but so is your ability to manage and grow your practice. This means knowing your numbers (clients, retention, revenue, and costs) and implementing efficient practice management systems. These systems aren’t just about paperwork; they're tools that streamline everything from scheduling, billing, and documentation, to marketing and staffing. Embrace the business owner mindset and watch your practice thrive.

Ask Yourself:

• Do you regularly revi...

As medical exercise professionals, getting comfortable when your schedule fills up with regular clients is easy. But have you ever wondered what happens when your client list remains unchanged for years? While consistent client sessions might feel stable, this approach can limit your practice's growth and your ability to help even more people.

Dr. Mike shares an essential insight: successful medical exercise practices aren't built solely on client sessions—they're built on systems. Systems are repeatable processes that efficiently handle key areas of your business, freeing you to focus on growth and professional development. Instead of just being a technician who addresses immediate needs, a system-focused professional creates sustainable solutions for a larger number of clients.

Critical systems to implement include:

• Assessment Systems: Develop consistent protocols tailored to specific medical conditions to streamline client evaluations.
• Scheduling and Onboarding: Automate appoi...

Medical Exercise Specialists, this post reviews how to price Medical Exercise Training (MET) services effectively by understanding your real costs and the valuable outcomes you provide to clients. Pricing should reflect the effort, expertise, and significant improvements you bring to your clients' daily lives, such as reducing discomfort, improving strength, or restoring important activities. Pricing too low can create financial stress and suggest lower quality service to clients.

Avoid setting prices just by comparing yourself with competitors, as this can result in unsustainable price wars. Instead, base your rates on your actual costs, including expenses like travel, insurance, and professional time spent on client education and follow-up with medical professionals. Your pricing should also clearly represent the professional value and quality of the services you offer.

Understanding your client's perspective on pricing is important. Clients highly value the positive changes MET br...

Managing clients with medical conditions demands more than just exercise prescription—it requires a strategic and thoughtful approach. In a recent insightful webinar, Dr. Mike reviewed the comprehensive 6-Point Medical Exercise Program Management System that transforms how medical exercise specialists approach their practice, driving superior outcomes and facilitating potential insurance reimbursements.

Here's a detailed breakdown of this transformative approach:

1. Clinical Anatomy and Pathology Knowledge

A clinical anatomy understanding of your client's condition is fundamental. It's essential to comprehend the specific anatomical impacts of their condition, whether due to disease, injury, or surgery, to ensure accurate exercise programming.

2. Identifying Contraindications

Safety comes first. Clearly identifying exercises and activities that could harm your client based on their medical history and condition is crucial. Understanding contraindications prevents injury and enhanc...

Let’s be honest—most Medical Exercise Professionals aren’t struggling because they lack exercise knowledge.

They’re struggling because no one ever taught them how to run a business.

If you're frustrated with inconsistent referrals, unsure about your pricing, overwhelmed by documentation, or avoiding conversations with physicians, it's time for a reset—and a wake-up call.

If you're a certified Medical Exercise/Fitness professional working with clients who have medical conditions, ask yourself:

• Am I consistently getting referrals from physicians and healthcare providers?

• Do I know how much it actually costs me to train a client—and am I pricing correctly?

• Can I take time off without my revenue dropping to zero?

• Do I have intake, documentation, and follow-up systems that look and feel professional?

• Am I confident when talking to physicians, billing for services, or promoting my business?

If you hesitate on even one of these, you’re not underperforming beca...

Impostor syndrome among Medical Exercise Specialists (MES) is not uncommon. In this post, Dr Mike discusses how Impostor syndrome happens when MES professionals doubt their skills, even after extensive training. During client assessments, this uncertainty can cause MESs to rely too heavily on basic personal training techniques, ignoring important aspects of medical exercise assessments such as anatomy or pathology. Avoiding these crucial points prevents specialists from effectively using their advanced training.

Another common sign of impostor syndrome is avoiding communication with doctors, therapists, and chiropractors who refer clients. Professionals might fear being asked questions they can't answer, but these medical providers mainly want updates about the exercise plan and progress—not medical diagnoses or treatments. Clear communication with medical providers is important for building professional credibility.

Having certifications alone doesn't build confidence. Confidence gr...