## **Procedure description**
HCPCS code G0023 covers principal illness navigation services (PIN services) delivered by certified or trained auxiliary personnel under the supervision of qualified health care practitioners. These PIN services are designed to assist patients living with a serious high-risk condition, such as cancer, heart failure, or chronic obstructive pulmonary disease, and are intended to improve care coordination and outcomes.
During principal illness navigation (PIN) services, a principal illness navigation peer or certified peer specialist may provide illness navigation peer support as part of the patient's treatment team. This can include social and emotional support, health education, and guidance tailored to the patient's life story, cultural background, and preferences and desired outcomes. Attention to cultural and linguistic factors is critical to ensure personalized and effective treatment.
Trained auxiliary personnel deliver these services across settings such as hospitals, clinics, skilled nursing facilities, and other health care facilities, often working alongside community-based service providers to ensure seamless coordination of care. The goal is to enhance communication, promote patient self-advocacy, and support ongoing engagement by promoting patient motivation and aligning interventions with the individual’s goals.
By bridging gaps across health care facilities and community resources, illness navigation PIN services empower patients and families to actively participate in care, improving both clinical outcomes and quality of life.
## **Documentation requirements**
Records should clearly outline the role of the patient navigator in assisting individuals with complex care needs and serious conditions. Documentation must reflect the use of peer support and collaboration with the health care team to address patient goals and barriers to care.
Key elements to document include:
- A person-centered assessment highlighting the patient’s condition, needs, and care preferences.
- Clear notes on how navigation services helped reach person-centered diagnosis and facilitated care coordination.
- Evidence of peer support specialists' involvement in providing guidance, encouragement, or emotional support.
- Interventions that promote patient self-advocacy skills, ensuring individuals are empowered to participate in their care.
- Records of coordination across settings, including primary care, specialty care, or after an emergency department visit.
- Activities related to community health integration, showing efforts to connect patients with community-based resources and services.
## **Billing requirements**
Billing practitioners must ensure services are delivered under the direction of a physician or by personnel under the direction of appropriate supervisory providers. A qualified billing practitioner is required to oversee all care coordination activities.
Key billing considerations include:
- Services may include structured communication, navigation, and referrals to address behavioral health conditions, severe mental illness, or complex chronic conditions.
- Interventions must demonstrate support for the patient’s person-centered diagnosis, while leveraging the patient’s psychosocial resources, such as their psychosocial strengths, to improve health outcomes.
- The care plan should reflect linkages to community-based social services, related community-based services, and home and community-based supports.
- Document coordination during transitions involving referral to specialists or referring patient activities to maintain continuity of care.
- Activities may include providing emotional support, education, or connecting patients with appropriate resources.
## **Other relevant codes**
- G0019: Community health integration (CHI) Services, the initial 60 minutes per calendar month performed by certified or trained auxiliary personnel under supervision.
- G0022: Community health integration services, each additional 30 minutes per calendar month
- G0018: Initiating visit for Principal Illness Navigation (PIN) services, covering the evaluation and management visit with all care addressed in the initiating process.
Frequently asked questions
