PIN vs CHI: Medicare Navigation Codes G0023 and G0019 Explained

Updated November 2026. Written by Matteo Grassi, clinical psychologist and cofounder of HANA Health.

Principal Illness Navigation (PIN) and Community Health Integration (CHI) are Medicare care management services, both started in 2024, that pay for 60 minutes a month of work by trained auxiliary staff. PIN helps a patient with one serious, high risk condition move through their care. CHI addresses social needs that block diagnosis or treatment. In 2024, Medicare billed only 7,934 PIN services and 41,362 CHI services nationwide.

As a clinical psychologist, I've watched how much of a serious diagnosis turns out to be logistics, and these two codes are Medicare's first real attempt to pay for that work.

Key facts

• Start date: CMS created PIN (G0023, G0024, G0140, G0146) and CHI (G0019, G0022) in the CY2024 Physician Fee Schedule final rule, effective 1 January 2024.
• Time threshold: both base codes need 60 minutes of staff time in a calendar month; each add on code covers 30 more minutes (CMS FAQ).
• PIN eligibility: one serious, high risk condition expected to last at least 3 months, such as cancer, COPD, heart failure, dementia or severe mental illness (CMS FAQ).
• CHI eligibility: unmet upstream drivers, such as food, housing or transportation problems, that significantly limit the practitioner's ability to diagnose or treat (CMS FAQ).
• Use in 2024: 7,934 PIN services and 41,362 CHI services were submitted to traditional Medicare; 14.6% of PIN and 28.2% of CHI services were denied (JAMA Health Forum, 2026).
• Cost sharing: the patient pays 20% of the Medicare approved amount after the Part B deductible (Medicare.gov).

What is the difference between PIN and CHI?

PIN is organized around a diagnosis. CHI is organized around a barrier. That's the simplest way to choose between them.

PIN fits a patient who has just been diagnosed with something serious, like cancer or heart failure, and needs someone to help them get appointments, understand the plan and keep going. The condition must be expected to last at least 3 months and put the patient at significant risk of hospitalization, nursing home placement, sudden decline or death. It also has to need a disease specific care plan that gets monitored or revised.

CHI fits a patient whose care is stuck because of something outside the clinic. No ride to dialysis. No refrigerator for insulin. A utility shutoff that makes home oxygen unsafe. The practitioner has to identify that unmet need during the initiating visit and judge that it significantly limits their ability to diagnose or treat the problem they addressed.

Some patients fit both. A patient with a new cancer diagnosis who also can't get to chemotherapy might qualify for either. In that case, pick the service that matches the main reason they need help, and write down why.

PIN also has a peer support version (G0140 and G0146) for serious behavioral health conditions, delivered by certified peer support specialists.

What does each code pay in 2026?

The four main codes pay almost the same amount, about $86 to $88 for the first hour and about $54 for each extra half hour, before locality adjustment.

National payment is the total relative value units (RVUs) multiplied by the conversion factor. For 2026, the non facility RVUs come from CMS's RVU26D relative value file and the conversion factor is $33.4009.

• G0023 (PIN, first 60 minutes): 2.61 RVUs × $33.4009 = 87.18 dollars a month.
• G0024 (PIN, each additional 30 minutes): $54.44.
• G0019 (CHI, first 60 minutes): 2.58 RVUs × $33.4009 = $86.17 a month.
• G0022 (CHI, each additional 30 minutes): $54.11.
• G0140 (PIN peer support, first 60 minutes): $89.18.

The patient's 20% share of G0019 is about $17.23. That copay matters more than it looks, and we'll come back to it.

What has to happen before you can bill?

Both services need an initiating visit by the same practitioner who will bill the monthly service. Without it, no claim.

The initiating visit

The initiating visit can be an E/M visit the billing practitioner performs personally, the E/M visit inside TCM, or an Annual Wellness Visit if that practitioner identifies the qualifying condition or need during it. A level 1 visit done by clinical staff doesn't count. Neither does an ED, inpatient or skilled nursing visit, because that practitioner won't provide the follow on care. For services tied to mental illness, a psychiatric diagnostic evaluation (90791) or health behavior assessment codes can also serve.

Consent

• PIN: written or verbal consent, documented in the record, before or when services start, then every year.
• CHI: advance consent, documented, obtained once. Tell the patient cost sharing applies and that only one practitioner can bill CHI each month.
• Both: get new consent if the billing practitioner changes.

Staff and supervision

The work is done by auxiliary personnel incident to the billing practitioner under general supervision. They must meet any state licensure or certification rules. Where a state has none, they need training in seven competencies, including patient communication, care coordination, advocacy, ethics and knowledge of either the condition (PIN) or local community resources (CHI).

Can you bill PIN or CHI with CCM, PCM or TCM?

Yes. CMS finalized that PIN and CHI can be billed in the same month as other care management services, as long as each service's requirements are met, it's medically necessary, and no minute or effort is counted twice (CY2024 final rule).

In practice this means separate time logs. If a care manager spends 25 minutes on a CCM patient's medication list and the same patient's navigator spends 60 minutes arranging oncology appointments, each service counts its own minutes. If the same person does both kinds of work, the documentation has to show which minutes went where. Our guide to which care management codes can be billed in the same month covers the wider stacking rules.

There are three limits worth knowing:

1. Only one practitioner can bill CHI for a patient in a given month.
2. One practitioner can't bill PIN for two different conditions for the same patient. A different practitioner can bill PIN for a second condition.
3. PIN and PIN peer support shouldn't be billed together for the same condition.

Why are so few practices billing these codes?

Because reaching 60 minutes a month, every month, with documentation, is hard. The data so far show steep drop off between the patients who need navigation and the claims that get paid.

The JAMA Health Forum analysis of 2024 traditional Medicare claims found only 7,934 PIN services and 41,362 CHI services in the program's first year. Most were billed by primary care physicians in office settings, and more than a quarter of CHI services were denied. The authors point to documentation burden, staffing and workflow as likely barriers, though the study design can't prove why claims were denied.

A 2026 abstract in JCO Oncology Practice from one academic cancer center shows the funnel up close. Of 4,874 consented patients with navigation time recorded, only 563 (12%) reached the 60 minutes needed for a first G0023 claim. Only 11% of those had a claim in a second month, and 38% of submitted PIN claims were rejected or still pending. Staff also worried that copays discouraged patients from accepting navigation.

That's one site, and an abstract rather than a full paper. Still, it matches the national picture: the hard part isn't the code, it's keeping enough contact going to cross the time threshold.

What this means for your practice

Start with the patients you already see. Most practices have patients with a new serious diagnosis or a clear social barrier sitting on their schedule this month.

• Pick one service first. If your panel skews toward cancer, heart failure or dementia, start with PIN. If transportation and food access keep derailing visits, start with CHI.
• Build the initiating visit into the template. Add a prompt so the practitioner documents the qualifying condition or need and the plan for navigation in that visit.
• Script consent, including the copay. Patients who hear about cost sharing upfront are less likely to drop out after the first statement.
• Track time from day one. Log minutes by service and by staff member, so you can see in week three whether a patient will reach 60 minutes.
• Watch denials monthly. Early denials usually point to a missing initiating visit or consent note.

If you already run chronic care management, you have most of the infrastructure. HANA Health builds patient outreach for care management programs, and you can see how it works on our care management page.

Frequently asked questions

Can a nurse practitioner bill PIN or CHI?

Yes. Physicians, nurse practitioners, physician assistants and certified nurse midwives can bill. Clinical psychologists, clinical social workers, marriage and family therapists and mental health counselors can bill directly when the services relate to the diagnosis or treatment of mental illness.

Can PIN or CHI be done by phone?

Yes, the monthly services don't need to be face to face, and CMS didn't add them to the telehealth list for that reason. The initiating visit is different and must meet the rules for an E/M visit, AWV or the other qualifying visits.

Can staff from an outside organization deliver PIN or CHI?

Yes, as long as they work incident to the billing practitioner under general supervision and meet incident to and state requirements. Community based organizations can provide this staff. The billing practitioner still owns oversight.

Does a patient need a new initiating visit every year?

For PIN, Medicare.gov says patients need another initial visit after a year if they still need services, and consent must be renewed annually. For CHI, consent is needed once unless the billing practitioner changes.

Can a patient get PIN for two conditions at once?

Yes, but not from the same billing practitioner. A patient getting navigation for substance use disorder through one practitioner can get cancer navigation through another.

Sources

1. Centers for Medicare & Medicaid Services. CY2024 Physician Fee Schedule final rule. Federal Register, 2023. federalregister.gov
2. Centers for Medicare & Medicaid Services. Caregiver Training, Community Health Integration, Principal Illness Navigation FAQ. cms.gov
3. Centers for Medicare & Medicaid Services. PFS Relative Value Files, RVU26D, 2026. cms.gov
4. Medicare.gov. Principal illness navigation services. medicare.gov
5. Billig JI, et al. Early Adoption of Services for Health-Related Social Needs in Medicare. JAMA Health Forum, 2026. doi.org
6. Rocque GB, et al. Use and perceptions of principal illness navigation billing codes in oncology. JCO Oncology Practice, 2026. doi.org

This article is educational and isn't billing, coding, clinical or legal advice. Check current CMS guidance and your MAC before you bill. If you want to talk through navigation or care management outreach for your practice, book a call with me.