08/19/2024

CMS Payment for Principal Illness Navigation: How Do I Credential My Navigators?

New codes are now available to pay for Principal Illness Navigation (PIN) for illnesses expected to be managed for 3 months or longer (G0023, G0024). PIN services can be performed by a patient navigator, community health worker (CHW), or other nonclinical healthcare staff working under the general supervision of a billing practitioner. Additional codes are available for Community Health Integration (G0019, G0022, G0511 for Federally Qualified Health Centers); PIN services by peers (G0140, G0146); and Social Determinants of Health Risk Assessment (G0136).

The rule reminds us that existing codes for clinical care management are still available, and these new codes do not replace those existing codes. For example, Chronic Care Management (99437, 99439, 99490, 99491), Complex Chronic Care Management (99487, 99489), and Principal Care Management (99424-99427) codes remain appropriate to bill for the management of patients with cancer or other chronic conditions that are reasonably expected to last 3 months or longer. 

The new G-codes for PIN may be used by auxiliary personnel, including CHWs, patient navigators, social workers, nurses, and any other qualified person performing navigation functions. Organizations may also contract with community-based organizations to provide and bill for these services.

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