## **Procedure description**
HCPCS code G0019 refers to community health integration services (CHI), which support patients in bridging clinical care with home and community-based resources. These services are designed to ensure that care aligns with a patient’s preferences and desired outcomes, with a focus on addressing social determinants of health (SDOH) that may impact recovery and well-being.
Under community health integration, a person-centered assessment is performed to identify needs, considering cultural and linguistic factors, social and emotional support, and patient self-advocacy skills. Services are often delivered by a community health worker or certified or trained auxiliary personnel under the supervision of qualified health care practitioners.
These efforts emphasize community health integration CHI by promoting patient engagement, supporting coordination with community-based service providers, and ensuring communication with the patient’s treatment team across health care facilities and other health care facilities. The use of trained auxiliary personnel strengthens continuity of care and helps promote patient motivation for improved health outcomes.
Additionally, CHI services can extend into skilled nursing facilities and support transitions of care, ensuring patients maintain access to personalized and effective diagnosis and treatment plans. By focusing on the goals, preferences, and desired outcomes of each patient, providers enhance care coordination and patient access to healthcare while addressing barriers linked to determinants of health SDOH.
## **Documentation requirements**
To support billing for HCPCS code G0019, providers must ensure records clearly demonstrate the scope of services and the patient-centered approach to care:
- Document the initiating visit in detail, with all concerns addressed in the initiating process.
- Record a person-centered assessment performed to evaluate needs and reach a person-centered diagnosis.
- Outline diagnosis and treatment goals that align with the patient’s health and social circumstances.
- Include notes on community-based social services, related community-based services, or social service providers involved in care.
- Show how health education was provided to help patients understand their life story and support their health journey.
- Indicate any health integration services performed to promote continuity of care and coordination within the health care team.
## **Billing requirements**
For HCPCS Code G0019, billing requires compliance with payer guidelines and proper alignment of documented services with coverage rules:
- Reference the initiating visit and ensure all care addressed in the initiating process is documented.
- Note if the patient had an emergency department visit or transitions to a hospital or skilled nursing facility.
- Confirm that services performed by certified personnel were supervised by a qualified practitioner.
- Ensure compliance with Medicaid services and other payer-specific rules.
- Document how diagnosis and treatment goals were incorporated into care planning.
- Capture coordination of related community-based services and transitions involving referral when needed.
- Highlight the role of health education and how it supports improved patient access healthcare.
## **Other relevant codes**
- G0022: Community health integration services, each additional 30 minutes per calendar month
- G0018: Psychotherapy for crisis furnished in an applicable site of service (any place of service at which the non-facility rate for psychotherapy for crisis services applies, other than the office setting); each additional 30 minutes (list separately in addition to code for primary service)
- G0023: Principal illness navigation services by certified or trained auxiliary personnel under the direction of a physician or other practitioner, including a patient navigator; 60 minutes per calendar month
Frequently asked questions
