The other half of healthcare finally has a code.

More than two-thirds of what determines a person's health happens outside a clinic — food, transport, housing, caregiving, behavioral health, social isolation.[6] For a healthy 30-year-old this is invisible. For a 78-year-old on chemotherapy, an HIV-positive patient with substance use disorder, or a frail Medicare patient with advanced heart failure, it is the difference between staying home and ending up back in the hospital.

There are roughly 67 million people enrolled in Medicare today.[4] The U.S. records about 2 million new cancer cases every year.[5] Roughly 53 million Americans serve as unpaid family caregivers — and most are also working full-time.[7] The non-clinical pressure on these households is enormous, and historically Medicare paid for none of the work that addresses it.

A physician office is built to deliver clinical care: diagnose, prescribe, treat, follow up. It is not built to coordinate a chemo ride from a daughter who is back at her job, or to find a county food pantry that delivers in a specific ZIP code, or to call a behavioral-health specialist who actually has openings, or to teach a caregiver how to manage a feeding tube without burning out.

And historically, even when physician practices did this work — and many do, every day — there was no way to bill for it under Medicare. So it stayed invisible: an unpaid favor from the office's social-minded staff, a sticky note on a triage desk, a phone call between visits.

The result is the seriously-ill ER cycle: patient gets sicker between visits because a non-clinical need was missed, ends up in the ED, gets admitted, gets discharged with the same unmet need, and re-presents weeks later. Caregivers collapse. Treatment plans fail. Outcomes slide. Costs explode.

In the CY2024 Physician Fee Schedule final rule, CMS created a brand-new family of services for "auxiliary personnel under the general supervision of a billing practitioner" to deliver person-centered support to a patient with a serious, high-risk condition.[2] Medicare.gov puts it bluntly: PIN services help a patient "identify and connect with appropriate clinical and support resources."[1]

CMS named nine specific service elements that a PIN program is expected to address. Navigate Care's checklist mirrors them one-for-one:

• 01Person-centered assessment of health-related social needs
• 02Practitioner, home, and community-based care coordination
• 03Health education tailored to the patient's serious illness
• 04Building patient self-advocacy skills
• 05Health-care access / health-system navigation
• 06Facilitating behavioral health treatment when needed
• 07Identifying and addressing communication and language barriers
• 08Social and emotional support
• 09Leveraging lived experience (peer support, where applicable)

CMS calls out that PIN-Peer Support variants (G0140 / G0146) are designed for certified peer support specialists, particularly for behavioral health and substance use disorder navigation.[3]

CMS's eligibility bar is intentionally specific:[1]

• A serious, high-risk condition expected to last ≥3 months
• Examples named by CMS: cancer, HIV, sickle cell, dementia, advanced heart failure, substance use disorder
• At risk of hospitalization, nursing-home placement, sudden worsening, decline, or death
• An initiating E/M (or qualifying) visit with the billing practitioner before PIN can begin
• Documented patient consent — including cost-sharing disclosure — at or before the first PIN service of the month

In practice, that captures most active oncology patients, advanced heart failure, advanced COPD, dementia, end-stage renal disease, sickle cell, HIV with comorbidity, and a wide range of substance use disorder cases — exactly the populations whose outcomes are decided outside the exam room.

PIN is billed in calendar-month time increments by the supervising practitioner, using HCPCS G-codes published in the CY2024 Physician Fee Schedule.[2] National-average payments below are illustrative — your locality, payer mix, and any geographic adjustment will move the number; always confirm in the CMS Physician Fee Schedule Look-Up Tool.[8]

Crucially, PIN can be billed alongside other care-management codes (CCM, PCM, BHI), and concurrently with the SDOH risk-assessment code G0136 and Community Health Integration G0019/G0022, as long as time is not double-counted.[3]

PIN is conceptually simple. Operationally it is unforgiving. To bill defensibly each calendar month, the practice must produce, per patient: documented eligibility from a qualifying E/M; consent on file with cost-sharing disclosure; the supervising practitioner's identity; the navigator's identity; the specific PIN service elements addressed; the activities performed; and time-stamped minutes that cleanly cross the 60-minute threshold for G0023 and each subsequent 30-minute increment for G0024.

A spreadsheet cannot do this at scale. It cannot dial the patient and time the call. It cannot transcribe the conversation, capture the patient's preferred reminder time, and turn it into a recurring task. It cannot stop the clock at the right minute, identify the threshold crossing, and produce an audit packet.

A platform can. Navigate Care is that platform: built around the calendar-month minute, the audit trail, and the way physician offices actually run.

Take the most common case: a practice running PIN for 100 eligible patients a month, where the average patient earns G0023 (first 60 minutes) plus one G0024 (an additional 30 minutes). At national-average CY2024 PFS rates that's roughly $79 + $49 = ~$128 per patient per month, or about $1,540 per patient per year.

The revenue is the headline. The harder-to-measure win is the unit economics: when a navigator closes a transportation gap before chemo, or links a patient to a county food bank, or coordinates a behavioral-health warm handoff, the practice avoids the downstream ED visit and the late-stage admission.