Using codes G0023, G0024, G0140 and G0146 for PIN services
Keep up with changes to coding for Medicare and Medicaid patients with high-risk conditions.
Starting in 2024, the CMS finalized new codes to pay for providing principal illness navigation (PIN) services.
These codes are part of the Healthcare Common Procedure Coding System (HCPCS).
Overview of PIN services codes
There are two types of PIN services:
General PIN services address conditions such as cancer, chronic obstructive pulmonary disease and congestive heart failure.
Principal illness navigation-peer support (PIN-PS) services address the needs of patients with a high-risk behavioral health condition.
PIN services are designed to provide additional support to patients with serious, high-risk conditions (i.e., for PIN-PS, serious, high-risk behavioral health conditions) expected to last at least three months and place the patient at significant risk of:
Hospitalization
Nursing home placement
Acute exacerbation or decompensation
Functional decline or death
PIN services also support patients with conditions requiring the development, monitoring or revision of a disease-specific care plan and potentially requiring frequent adjustment in the medication or treatment regimen or substantial assistance from a caregiver.
PIN services include items such as:
Assisting in health system navigation
Supporting person-centered planning
Identifying or referring patients and caregivers or family, if applicable, to supportive services
Promoting patient self-advocacy
Facilitating access to community-based resources
Read the CMS PIN code descriptors
G0023 is used to indicate PIN services provided by certified or trained auxiliary personnel under the direction of a physician or other health care practitioner, including a patient navigator. These services include 60 minutes per calendar month in the following activities:
- Conducting a person-centered assessment to understand the patient’s life story, strengths, needs, goals, preferences and desired outcomes, including understanding cultural and linguistic factors and including unmet social determinants of health (SDOH) needs not separately billed
- Facilitating patient-driven goal setting and establishing an action plan
- Providing tailored support as needed to accomplish the practitioner’s treatment plan
- Identifying or referring patient (and caregiver or family, if applicable) to appropriate supportive services
- Supporting practitioner, home- and community-based care communication, including:
- Coordinating receipt of needed services from health care practitioners, providers and facilities as well as home- and community-based service providers and caregivers (if applicable)
- Communicating with practitioners, home- and community-based service providers, hospitals and skilled nursing facilities (or other health care facilities) regarding the patient’s psychosocial strengths and needs, functional deficits, goals, preferences and desired outcomes, including cultural and linguistic factors
- Coordinating care transitions between and among health care practitioners and settings, including transitions involving referral to other clinicians, follow-up after an emergency department visit or follow-up after discharges from hospitals, skilled nursing facilities or other health care facilities
- Facilitating access to community-based social services (e.g., housing, utilities, transportation, food assistance) as needed to address SDOH need(s).
- Health education—helping the patient contextualize health education provided by the patient’s treatment team with the patient’s individual needs, goals, preferences and SDOH need(s) and educating the patient (and caregiver if applicable) on how to best participate in medical decision-making
- Building patient self-advocacy skills so that the patient can interact with members of the health care team and related community-based services as needed, in ways that are more likely to promote personalized and effective treatment of their condition
- Health care access/health system navigation. This includes:
- Helping the patient access health care, including identifying appropriate practitioners or providers for clinical care and helping secure appointments with them
- Providing the patient with information and resources to consider participation in clinical trials or clinical research, as applicable
- Facilitating behavioral change, as necessary for meeting diagnosis and treatment goals, including promoting patient motivation to participate in care and reach person-centered diagnosis or treatment goals
- Facilitating and providing social and emotional support to help the patient cope with the condition, SDOH need(s) and adjust daily routines to better meet diagnosis and treatment goals
- Leveraging knowledge of the serious, high-risk condition and/or lived experience when applicable to provide support, mentorship or inspiration to meet treatment goals
Principal illness navigation services, additional 30 minutes per calendar month (List separately in addition to G0023)
G0140 is used to indicate PIN services provided by certified or trained auxiliary personnel under the direction of a physician or other practitioner, including a patient navigator. These services include 60 minutes per calendar month, in the following activities:
- Conducting a person-centered interview, performed to understand the patient’s life story, strengths, needs, goals, preferences and desired outcomes, including understanding cultural and linguistic factors and including unmet SDOH needs (that aren’t separately billed)
- Facilitating patient-driven goal setting and establishing an action plan
- Providing tailored support as needed to accomplish the practitioner’s treatment plan
- Identifying or referring patient (and caregiver or family, if applicable) to appropriate supportive services
- Supporting practitioner, home- and community-based care communication, including:
- Assisting the patient in communicating with their practitioners, home- and community-based service providers, hospitals and skilled nursing facilities (or other health care facilities) regarding the patient’s psychosocial strengths and needs, goals, preferences and desired outcomes, including cultural and linguistic factors
- Facilitating access to community-based social services (e.g., housing, utilities, transportation, food assistance) as needed to address SDOH need(s)
- Health education—helping the patient contextualize health education provided by the patient’s treatment team with the patient’s individual needs, goals, preferences and SDOH need(s) and educating the patient (and caregiver if applicable) on how to best participate in medical decision-making
- Building patient self-advocacy skills, so the patient can interact with members of the health care team and related community-based services as needed, in ways more likely to promote personalized and effective treatment of their condition
- Developing and proposing strategies to help meet person-centered treatment goals and supporting the patient in using chosen strategies to reach person-centered treatment goals
- Facilitating and providing social and emotional support to help the patient cope with the condition, SDOH need(s) and adjust daily routines to better meet diagnosis and treatment goals
- Leveraging knowledge of the serious, high-risk condition and/or lived experience when applicable to provide support, mentorship or inspiration to meet treatment goals
G0146 is used to indicate each additional 30 minutes of PIN peer support services provided in a calendar month (list separately in addition to G0140)
Frequently asked questions on PIN services
What are the requirements for PIN services?
Patients must have an initiating visit before receiving PIN services. PIN initiating visits include:
- Evaluation and management (E/M) visits, including the E/M provided as part of transitional care management
- Annual wellness visits (when performed by a practitioner who will bill for PIN services)
- Psychiatric diagnostic evaluation (CPT code 90791)
- Health behavior assessment and intervention (CPT codes 96156, 96158, 96159, 96164, 96165, 96167 and 96168)
PIN initiating visits do not include:
- Low-level visits (e.g., 99211) performed by clinical staff
- Inpatient and observation visits, emergency department visits and skilled nursing facility visits
Subsequent PIN services may be provided by auxiliary staff, such as patient navigators and peer support specialists. Auxiliary staff may be employed by the practice or contracted through an external organization. PIN services do not need to be provided in-person, but CMS expects many aspects of PIN services to involve direct patient contact.
Are there specific training requirements for PIN service providers?
PIN services are provided incident-to professional services provided by a physician or other billing practitioner under general supervision.
Auxiliary staff must meet all incident-to requirements and any state requirements, including licensure. In states without applicable requirements, auxiliary staff must be certified and trained in the following competencies:
- Patient and family communication
- Interpersonal and relationship-building skills
- Patient and family capacity building
- Service coordination and systems navigation
- Patient advocacy, facilitation, individual and community assessment
- Professionalism and ethical conduct
- Development of an appropriate knowledge base, including specific certification or training on the serious, high-risk condition, illness or disease being addressed
When there are not applicable state requirements, auxiliary staff providing PIN-PS services should receive training consistent with the National Model Standards for Peer Support Certification published by the Substance Abuse and Mental Health Services Administration.
Auxiliary personnel may be employees, leased employees or independent contractors of the billing practitioner.
Is beneficiary consent required for PIN services?
Yes. Consent may be verbal or written but must be documented in the medical record and should be obtained annually. Consent should include explaining to the patient that cost-sharing will apply.
Are PIN services subject to deductible and coinsurance?
Yes. PIN services are subject to deductible and coinsurance. Some supplemental insurance plans may cover the patient’s cost sharing.
What are the documentation requirements for PIN services?
In addition to documenting patient consent, documentation must include the amount of time spent with the patient and the nature of the activities, including how they relate to the treatment plan. Any unmet social needs addressed by PIN services must also be documented. CMS encourages practices to document “Z codes,” when applicable.
How are PIN services billed?
PIN services are billed monthly and reported by the physician or practitioner who provided the initiating visit. PIN services may only be reported by the billing physician or practitioner once per month for any single serious high-risk condition.
Do private payers cover PIN services?
Most Medicare Advantage plans cover PIN services. For commercial plans, coverage varies by payer. Check with your provider relations representatives for additional information regarding their policies. Verify the patient’s benefits before providing PIN services.
How are PIN services different from other care management services (e.g., chronic care management [CCM])?
PIN services are similar to services such as CCM in that they provide additional, tailored support to patients. CCM services are primarily focused on clinical aspects of care and limited to patients with two or more chronic conditions. PIN services are focused on patient support and social aspects of care.
Can PIN services and other care management services (e.g., CCM) be billed concurrently?
Yes. As long as the requirements for both services are met, PIN and other care management services may be reported in the same month. Time and effort for both services must be unique. Don't count the same time and work more than once. PIN and PIN-PS services shouldn't be reported concurrently for the same condition.
How are community health integration (CHI) and PIN services different?
CHI and PIN services are very similar. A key difference is CHI services focus on addressing patients’ unmet social needs. PIN services focus on helping patients with a serious high-risk condition navigate the health care system and guiding them through their course of care. Patients receiving PIN services may also have unmet social needs, but it isn't a requirement.