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Community health integration codes G0019 and G0022
Community health integration codes G0019 and G0022 pay for clearing a social barrier that blocks diagnosis or treatment.
Short answer: G0019 describes 60 minutes per calendar month of community health integration by certified or trained auxiliary personnel under a practitioner’s direction. The service addresses upstream drivers that significantly limit diagnosis or treatment; G0022 describes each additional 30 minutes in the month.
G0019 is the Medicare community health integration, or CHI, base code for addressing upstream drivers that significantly limit the billing practitioner’s ability to diagnose or treat a problem. G0022 is its monthly additional-time code, and both depend on a qualifying need, initiating visit, consent and personnel arrangement.
CHI is tied to a patient’s medical care rather than a broad eligibility label for community support. The practice should connect the identified barrier, the clinical problem and the monthly work before selecting the claim.
The unmet need must connect to medical care
Clinical link: The practitioner identifies an upstream driver significantly limiting diagnosis or treatment.
Personnel: Auxiliary personnel must meet state and CMS requirements and work under general supervision.
Monthly service: Time and activities relate to the practitioner’s plan and are documented for review.
G0019 and G0022 code descriptions
These HCPCS codes describe community health integration under a physician or other practitioner’s direction. The base and add-on concern the calendar month; an additional-time code does not stand alone as a separate service.
| Question | G0019 | G0022 |
|---|---|---|
| Role | Base CHI service | Additional CHI time |
| Time in descriptor | 60 minutes per calendar month | Each additional 30 minutes per calendar month |
| Pairing | Qualifying monthly CHI service | Reported in addition to G0019 |
| Frequency statement | Monthly base service | No frequency limit when the time is reasonable and necessary |
CMS replaced “social determinants of health” with “upstream driver(s)” in the CHI descriptor for CY2026. It also removed “E/M” from the descriptor’s initiating-visit reference; that change does not remove the initiating visit itself.
If an older article uses the earlier terminology, check the current clinical connection rather than relying on the old label. The social determinants of health guide provides broader context, while this page concentrates on the CHI code requirements.
What makes an upstream driver relevant to G0019
The billing practitioner must identify an unmet upstream driver that significantly limits diagnosis or treatment of the problem addressed in the initiating visit. CMS also allows relevant drivers identified later during the CHI service to be addressed.
There is no requirement tied to the patient’s community. A place-based label or an assumption about a neighborhood does not replace the individual unmet need and its effect on medical care.
- Identify the medical problem being addressed by the practitioner.
- Describe the unmet upstream driver and how it limits diagnosis or treatment.
- Connect the proposed CHI activities to that specific barrier.
- Return newly identified needs to the practitioner for clinical review.
The practical question is what is preventing care from proceeding and how the integration service addresses it. A general statement that a patient needs support leaves the billing team without the required clinical connection.
CHI differs from principal illness navigation, which concerns navigation around a serious, high-risk condition. The PIN code guide explains that separate service and its condition-specific requirements.
Which visit can initiate community health integration
The practitioner who bills CHI identifies the need
A personally furnished evaluation and management visit may initiate CHI when the billing practitioner identifies the unmet upstream driver limiting diagnosis or treatment. A level-one visit furnished by clinical staff does not qualify.
The evaluation and management visit within transitional care management may qualify. An annual wellness visit may also qualify if that same practitioner performs it and identifies a driver that prevents the patient from carrying out the personalized prevention plan.
For eligible behavioral health practitioners personally diagnosing or treating mental illness, CMS permits CPT 90791 or qualifying health behavior assessment and intervention services to serve as initiating visits. The same-practitioner relationship remains part of the rule.
Confirm the practitioner, not simply the encounter date
An emergency department or inpatient visit does not qualify when its practitioner will not also furnish the subsequent CHI services. The record should show why the specific encounter establishes this practitioner’s later integration work.
Do not assume that any recent wellness or office encounter satisfies the requirement. Review who furnished it and whether the relevant medical problem and unmet driver were addressed.
Consent, patient costs and personnel requirements
Obtain advance consent and explain the service
The billing practitioner or auxiliary personnel may obtain CHI consent in advance. It may be written or verbal, must be documented in the medical record and is generally obtained once, with new consent if the billing practitioner changes.
The patient must be told that cost sharing applies and that only one practitioner per month can bill CHI. The usual Medicare Part B deductible and coinsurance apply, so the practice should not make a universal patient-cost promise.
Verify training and the supervision arrangement
Auxiliary personnel must be certified or trained to furnish all included service elements and authorized under state law. Applicable state certification or licensure requirements govern; where none apply, CMS specifies competency-based training or certification.
- Communication, relationship building and patient or family capacity building.
- Service coordination, system navigation and patient advocacy.
- Professional conduct and knowledge of local community resources.
Those grouped topics summarize CMS’s competencies rather than replace its complete list. CHI may be furnished under general supervision of the billing practitioner, and contracted external personnel must satisfy incident-to and payment conditions.
A service agreement or job title does not by itself verify the assigned person’s training. Confirm the personnel requirements for the actual arrangement before relying on the service for a claim.
Review the monthly work and records
1. Confirm the need and the plan connection
Begin with the barrier identified by the practitioner and the work intended to address it. If auxiliary personnel find another relevant need, CMS says they should consult the billing practitioner rather than independently expanding the clinical basis for the service.
2. Record activities and time for review
CMS requires the record to reflect auxiliary personnel’s time and activities in relation to the practitioner’s plan. It does not specify who must enter the information, provided the billing practitioner reviews and verifies the documentation.
When upstream drivers are addressed, document them in the medical record. CMS permits the relevant Z-code set to document those drivers, but coding a barrier does not itself document the integration work performed.
3. Check the service before the additional time
- Confirm the initiating visit, identified need and documented advance consent.
- Verify the personnel arrangement and required competencies.
- Review the monthly work, its connection to the plan and recorded time.
- Check other care-management services for duplicated time or effort.
- Have the billing practitioner review and verify the record before submission.
The descriptor specifies the time, but this guide does not establish a partial-time billing convention. Confirm an uncertain shortened-service claim and current processing edits with your MAC instead of assuming that a fraction of the stated time qualifies.
CHI alongside other care-management services
CHI may accompany CCM or PCM when each service’s requirements are met, the work is reasonable and necessary, and time and effort are not counted twice. CMS also permits CHI alongside APCM without removing CHI’s own qualifying requirements.
Check these limits before submitting
Home health plan: CHI cannot be billed while the patient is under a Medicare Part B home health plan of care.
Duplicate work: Permitted concurrent care management still cannot count the same time and effort twice.
Another navigation service: Do not assume a same-practitioner PIN-and-CHI combination from the general concurrent-billing rule.
CHI may be furnished through telecommunications technology. CMS treats it as outside the Medicare telehealth-services category because it ordinarily occurs outside face-to-face visits; absence from the Telehealth Services List does not by itself prohibit remote CHI.
For the PIN-and-CHI scenario, confirm the specific claim with the MAC rather than treating an inference as an express CMS rule. Keep each qualifying need and the distinct work visible in the practice record.
Agree the clinical handoff and monthly record
A practice evaluating community health integration services should start with how the practitioner identifies the unmet need and reviews the work. Verify personnel requirements; which team members’ time counts toward each code is set in your services agreement.
Companian: “Your team refers; we handle enrollment, outreach and documentation. You bill monthly under your license.”
Key takeaways
- G0019 describes monthly CHI addressing upstream drivers that significantly limit diagnosis or treatment.
- G0022 describes additional 30-minute increments in the same month.
- CHI requires documented advance consent and cost-sharing disclosure.
- The patient’s individual unmet need matters, rather than a community eligibility label.
- The billing practitioner reviews and verifies the monthly activities and time record.
Frequently asked questions about g0019
Did the 2026 G0019 wording change remove the initiating visit?
No, CMS changed the descriptor terminology to upstream drivers and removed its E/M label. A qualifying initiating visit remains necessary.
Is CHI limited to patients from a designated underserved community?
No, CMS did not create a requirement specific to the patient’s community. The individual unmet driver must significantly limit diagnosis or treatment.
Who may obtain the patient’s CHI consent?
The billing practitioner or auxiliary personnel may obtain advance consent. It must be documented, with cost-sharing and single-practitioner monthly disclosures.
Must CHI consent be repeated annually like PIN consent?
CHI consent is generally obtained once. A change in the billing practitioner requires a new consent.
Can CHI be billed during a Part B home health plan of care?
No, CMS bars CHI billing during that plan of care. Confirm the patient’s current service arrangement before submitting the monthly claim.
Does a Z code alone establish a monthly CHI service?
No, a Z code may document the upstream driver, while the record must also reflect time and activities related to the plan. The billing practitioner reviews and verifies that documentation.
Medicare Part B community health integration uses HCPCS G0019 and G0022 for qualifying work around upstream drivers in physician practices. Companian: “Your team refers; we handle enrollment, outreach and documentation. You bill monthly under your license.”
Read more: PIN code requirements · Social determinants context
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Rates & disclosures
National amounts are 2026 Medicare Physician Fee Schedule non-facility payments at the non-QP conversion factor of $33.4009, computed from CMS RVUs. Your amount depends on your Medicare payment locality; see it in the CCM/PCM revenue calculator. Actual payment depends on participation status, place of service and cost-sharing.
Sources:
- CMS, Health-Related Social Needs FAQ
- CY 2026 Physician Fee Schedule final rule (CMS-1832-F)
- CMS 2026 Physician Fee Schedule relative value files (RVU26D)
Disclosures
This guide summarizes CMS rules for practices nationwide. It is not legal or billing advice.