Reference
The Medicare codes that pay for a navigator.
Since January 2024 Medicare Part B has paid for two kinds of navigation: Community Health Integration, for when life is getting in the way of care, and Principal Illness Navigation, for when a serious illness has become too much to manage alone. Six HCPCS codes carry them. Here is what each one means, what Medicare pays and what the patient owes, from the CMS fee schedule.
Prefer to speak with someone? Call 628 234 2273 (NAV-234-CARE). Families: this is what the line on your Medicare statement means. Practices: this is what you can bill.
The six codes, 2026
What each code is, and what it pays.
National average payment for 2026, non-facility setting, at the standard conversion factor of $33.40. Actual payment is adjusted for geography. The last column is the patient's 20% coinsurance before any supplemental coverage — which usually pays it.
Community Health Integration services — first 60 minutes in a calendar month
- Time
- 60 min / month
- Medicare pays
- $86.17
- Patient's 20%
- ≈ $17.23
Community Health Integration — each additional 30 minutes (add-on to G0019)
- Time
- +30 min
- Medicare pays
- $54.11
- Patient's 20%
- ≈ $10.82
Principal Illness Navigation services — first 60 minutes in a calendar month
- Time
- 60 min / month
- Medicare pays
- $87.18
- Patient's 20%
- ≈ $17.44
Principal Illness Navigation — each additional 30 minutes (add-on to G0023)
- Time
- +30 min
- Medicare pays
- $54.44
- Patient's 20%
- ≈ $10.89
PIN – Peer Support, by a certified peer specialist, for behavioral health conditions — first 60 minutes
- Time
- 60 min / month
- Medicare pays
- $89.18
- Patient's 20%
- ≈ $17.84
PIN – Peer Support — each additional 30 minutes (add-on to G0140)
- Time
- +30 min
- Medicare pays
- $53.44
- Patient's 20%
- ≈ $10.69
Source: CMS, Calendar Year 2026 Physician Fee Schedule final rule (CMS-1832-F), Addendum B. Rates shown are for practitioners not in an Advanced Alternative Payment Model; the APM conversion factor is slightly higher. The Part B deductible applies before coinsurance and is met once a year across all Part B services.
Two benefits
Same shape, different problem.
Both benefits pay for the same kind of work — a trained person spending hours each month getting a patient's care to actually happen. They differ in why the patient needs it.
G0019 · G0022
Community Health Integration
For a patient whose care is being blocked by circumstances: no ride to dialysis, no reliable food, a house that is not safe, utilities about to be cut off, benefit forms nobody can face. The navigator's job is to remove the barrier so the treatment plan can work. CMS calls these health-related social needs, and from 2026, “upstream drivers of health”.
The full CHI guideG0023 · G0024
Principal Illness Navigation
For a patient with one serious, high-risk illness — cancer, advanced heart failure, dementia, kidney disease, serious COPD — that is expected to last at least three months and has become too complex to manage alone. The navigator coordinates specialists, treatment, transitions and follow-through. The peer-support codes G0140 and G0146 are the same benefit for behavioral health, delivered by certified peer specialists.
The full PIN guideNot sure which fits? PIN vs CHI settles it with one question.
What Medicare requires
Six conditions, every month.
These are the rules a practice has to meet to bill the codes, and therefore the things a family can expect to happen before navigation starts.
- An initiating visit. The billing practitioner must have seen the patient for an evaluation and management visit (or, for CHI, an Annual Wellness Visit) in which the problem the navigation will address was identified. Navigation cannot start from a phone call alone.
- Patient consent, documented in the record, before services begin — including that cost-sharing applies and that the patient may stop at any time. Consent can be verbal.
- For CHI: at least one health-related social need (housing, food, transportation, utilities, safety, paperwork, isolation) that is significantly limiting the practitioner's ability to diagnose or treat the problem addressed in the initiating visit.
- For PIN: one serious, high-risk condition expected to last at least three months, that places the patient at significant risk of hospitalization, nursing-home placement, functional decline or death, and whose management is complex enough to need navigation.
- The work is done by auxiliary personnel — community health workers, patient navigators, care coordinators, social workers, nurses or certified peer specialists — under the general supervision of the billing physician or non-physician practitioner, and the time is documented.
- Once per calendar month per practitioner. Time spent on other care-management services (Chronic Care Management, Principal Care Management, Transitional Care Management) in the same month cannot be counted twice.
For families
What this looks like on a Medicare statement.
Navigate Care bills Community Health Integration for its patients. Our line-by-line walkthrough shows the whole statement, and the cost page covers every coverage combination.
For practices
You can bill it. You do not have to staff it.
The codes belong to the treating practitioner; the hours belong to whoever does the navigation. Practices that want their patients to have a navigator without hiring one refer them to us: the initiating visit is yours, the monthly work is ours, and the patient keeps every doctor they have.
Questions about the codes
What is HCPCS code G0019?
G0019 is Medicare's code for Community Health Integration services: the first 60 minutes in a calendar month of work by a community health worker, navigator or similar staff, under a practitioner's direction, to address health-related social needs — rides, food, housing, utilities, paperwork — that are getting in the way of the patient's medical care. G0022 is the add-on for each additional 30 minutes. The 2026 national average payment for G0019 is $86.17, of which the patient's 20% share is about $17.23 unless supplemental coverage pays it.
What is HCPCS code G0023?
G0023 is Principal Illness Navigation: the first 60 minutes in a calendar month of navigation for a patient with one serious, high-risk condition expected to last three months or more — coordinating specialists, treatment, transitions and follow-through. G0024 adds each further 30 minutes. The 2026 national average payment is $87.18 for G0023 and $54.44 for G0024.
What is the difference between CHI and PIN?
The barrier. Community Health Integration (G0019, G0022) is for patients whose care is blocked by life circumstances: no ride, no food in the house, unstable housing, forms nobody can face. Principal Illness Navigation (G0023, G0024) is for patients whose serious illness has itself become too complex to manage. If the practical obstacles vanished and care would then work, that is CHI; if the patient would still be lost among specialists and a treatment plan, that is PIN. A patient can receive both in the same month from different practitioners, but the time cannot overlap.
How much does the patient pay for G0019 or G0023?
These are Medicare Part B services, so the annual Part B deductible applies first, then 20% coinsurance — roughly $17 for the first hour in a month at 2026 national rates. Medicaid, a Medicare Savings Program (QMB), Medigap and most retiree secondary plans pay that 20%, which is why the great majority of patients pay $0. Medicare Advantage plans set their own copays.
Who can bill G0019 and G0023?
Physicians and non-physician practitioners (nurse practitioners, physician assistants, clinical nurse specialists) who bill Medicare Part B and who conducted the initiating visit. The navigation itself is performed by auxiliary personnel — community health workers, patient navigators, care coordinators, nurses, social workers or certified peer specialists — under the practitioner's general supervision, as an incident-to service. Rural health clinics and federally qualified health centers bill these services under their own rules.
Do CHI and PIN require the patient's consent?
Yes. The practitioner or the auxiliary staff must obtain the patient's consent before the first month of services and document it, explaining that only one practitioner can bill the service per month, that cost-sharing applies, and that the patient may stop at any time. Verbal consent is acceptable as long as it is recorded in the medical record.
What happened to G0136?
G0136 was the 5–15 minute standardized social determinants of health risk assessment, created alongside CHI and PIN in 2024. From 1 January 2026 CMS redefined it as an assessment of physical activity and nutrition, so it no longer serves as the social-needs screen that leads into CHI. The initiating visit itself is where the need is now identified and documented.
Why do I see G0019 on my Medicare Summary Notice?
Because a practitioner billed Medicare for Community Health Integration services delivered to you that month — the work a navigator did coordinating rides, equipment, benefits, referrals or support at home. If you are a Navigate Care patient, this is the line for your navigator's time. Our guide to the Medicare Summary Notice walks through the statement, and if a line does not look right, call us and we will explain it.
Sources
- CMS — Calendar Year 2026 Medicare Physician Fee Schedule final rule (CMS-1832-F) fact sheet
- CMS — Physician Fee Schedule look-up tool (Addendum B relative value units by code)
- Federal Register — CY 2024 Physician Fee Schedule final rule, full text (the rule that created Community Health Integration and Principal Illness Navigation)
- CMS — Calendar Year 2024 Medicare Physician Fee Schedule final rule (CMS-1784-F), which created the codes
Guides
Read more about this
Community Health Integration: help when daily life gets in the way of care
Food access, transport, or your living situation can make a care plan hard to follow. Medicare may cover coordination to help address those barriers.
Principal Illness Navigation: eligibility, costs, and getting help
A serious illness can leave you managing appointments, referrals, and questions between visits. Medicare may cover a navigator to help you find and follow the care you need.
PIN vs CHI: which Medicare navigation benefit fits?
Two benefits, four billing codes, one deciding question — is the obstacle the illness, or is it life around the illness? Here's how to tell, and what to ask for.
How to read a Medicare Summary Notice
What Medicare paid, how Medigap claims are forwarded, and what to check before paying a provider’s bill.
Does Medicare cover a patient advocate?
Medicare covers navigation services for eligible patients. Here is how to check whether that help fits your situation, what you might pay, and how to get started.
Medicare Parts A, B, C and D, explained properly
Four letters, two systems, one very confusing set of choices. Here's what each part actually pays for — and the gaps nobody warns you about until a bill arrives.
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