Athletic Trainers Cannot Bill Insurance in Most States

Despite being licensed healthcare providers in nearly all 50 states, athletic trainers in most states cannot directly bill health insurance companies for their clinical services. Unlike physical therapists, occupational therapists, or physician assistants, ATs are frequently not recognized as eligible providers by third-party payers. Even in states where billing is technically possible, insurance companies routinely deny claims or refuse to credential ATs, forcing lengthy appeals processes that most school-based ATs do not have the administrative support to pursue. This inability to generate revenue is the single largest structural constraint on the profession's growth. When a physical therapist treats a patient, the clinic bills insurance and recovers $80 to $200 per session, justifying the therapist's salary. When an athletic trainer provides the same rehabilitative care to a student-athlete, the school absorbs the cost entirely. This means every AT position is a pure expense on a school or university budget, competing directly with coaching salaries, facility upgrades, and scholarship funds for limited athletic department dollars. The downstream effect is that administrators see AT positions as the easiest place to cut when budgets tighten. Why fund a second AT at $50,000 per year when that money could go toward a new weight room that recruits better athletes? The AT's clinical value is invisible to the balance sheet because none of their work generates a billing code. Meanwhile, the injuries they prevent and the ER visits they avoid never show up as savings in the athletics budget because those costs are borne by families and their insurers. This problem persists because the Centers for Medicare and Medicaid Services (CMS) does not recognize athletic trainers as qualified healthcare providers for Medicare reimbursement purposes, and private insurers follow CMS precedent. NATA has lobbied for federal recognition for decades, but the physical therapy and chiropractic lobbies have resisted expanding the provider pool. At the state level, gaining third-party reimbursement requires changing insurance regulations state by state, a process that takes years of legislative effort per state and faces opposition from incumbent provider groups who view ATs as competition.