Principal illness navigation codes G0023 and G0024

G0023 is the Medicare principal illness navigation, or PIN, base code for monthly support around a serious, high-risk condition. It describes 60 minutes of navigation by certified or trained auxiliary personnel under the billing practitioner’s direction, with a disease-specific care plan and other service requirements.

G0024 is its additional-time code. Before treating a navigation activity as billable, your practice needs to confirm the patient, initiating visit, consent, personnel and documented work rather than relying on the code label alone.

G0023 and G0024 code facts

These are HCPCS codes, even when a search calls them CPT codes. Their descriptors distinguish the monthly navigation service from additional time, and the general PIN pathway from its peer-support variant.

Code	Service	Time described	Relationship
G0023	Principal illness navigation	60 minutes per calendar month	General PIN base
G0024	Additional PIN	Each additional 30 minutes	Add-on to G0023
G0140	PIN peer support for qualifying high-risk behavioral conditions	60 minutes per month	Peer-support base
G0146	Additional PIN peer support	Each additional 30 minutes	Add-on to G0140

CMS did not finalize a frequency limit for the G0024 add-on. That does not turn additional units into an entitlement; the practice still needs qualifying navigation work and the applicable payment requirements.

The descriptor states the time, but this guide does not establish a partial-time billing rule. Confirm the required time convention and current claim edits with your MAC before reporting a shortened service.

Which patients qualify for G0023 navigation

The qualifying condition must be serious, high risk and expected to last at least three months. It must place the patient at significant risk of hospitalization, nursing home placement, acute worsening or decompensation, functional decline, or death.

The condition must also require development, monitoring or revision of a disease-specific care plan. Frequent treatment changes or substantial help from a caregiver may be part of the patient’s needs, but the practitioner must assess the actual situation.

• Cancer and chronic obstructive pulmonary disease appear among CMS’s examples.
• Congestive heart failure and dementia also appear in the examples.
• HIV/AIDS, severe mental illness and substance use disorder are included as examples.

The CMS list is not exhaustive. A diagnosis appearing in the examples should lead to a review of the qualifying clinical circumstances rather than an automatic billing decision.

PIN concerns navigation around the serious illness. The CHI code guide explains the separate focus on upstream drivers that block diagnosis or treatment; the Medicare patient advocate guide explains the broader terminology patients and practices may encounter.

The initiating visit and consent come before monthly billing

The billing practitioner furnishes the initiating visit

An eligible evaluation and management visit may initiate PIN, excluding a low-level visit that clinical staff can perform. The evaluation and management component of transitional care management may also qualify.

An annual wellness visit may qualify when that same practitioner furnishes it and identifies the high-risk condition meeting PIN criteria. CMS also permits psychiatric diagnostic evaluation CPT 90791 and qualifying health behavior assessment and intervention services when the same practitioner furnishes PIN.

An emergency department or inpatient visit cannot serve as the PIN initiating visit. Track the initiating practitioner rather than assuming that a hospital encounter establishes the later outpatient navigation service.

The billing practitioner obtains and documents PIN consent

The patient’s consent may be written or verbal, but must be documented in the medical record. The billing practitioner obtains it before or when services begin, renews it annually and obtains a new consent if the billing practitioner changes.

PIN carries the usual Part B deductible and coinsurance. Explain possible patient responsibility rather than describing all navigation as having no patient payment.

The yearly visit is separate from the monthly service

CMS sets no duration cap for PIN, but requires a new initiating visit each year. Keep a continuation reminder alongside the consent reminder; a continuing relationship does not remove either annual requirement.

Who furnishes navigation and what the practice must verify

PIN is generally furnished incident to the billing practitioner by auxiliary personnel under general supervision. Personnel may be external and under contract with the practice, such as through a community-based organization; auxiliary personnel do not bill Medicare independently for that work.

Personnel must meet applicable state certification or licensure requirements. Where no applicable state requirements exist, CMS requires training or certification in specified competencies, including knowledge of the serious condition being addressed.

• Patient and family communication, relationships and capacity building.
• Service coordination, systems navigation and patient advocacy.
• Professional and ethical conduct, with the appropriate condition-specific knowledge base.

These are summaries of the competency areas, not a substitute for checking CMS’s complete list and state requirements. CMS did not set a required number of training hours.

A job title alone does not establish that the assigned person meets the rule. Your practice should verify the personnel arrangement before relying on navigation time in a claim, including when an external organization supplies the person.

How to review a month of PIN work

1. Connect the work to the disease-specific plan

The navigation scope includes person-centered assessment, care coordination, health education, self-advocacy, system navigation, behavior change and social or emotional support. The record should make clear how the work relates to the practitioner’s plan for the high-risk illness.

2. Document the activities and time

CMS says the auxiliary personnel’s time and activities in relation to the plan of care should be reflected in the medical record. CMS does not require the auxiliary personnel themselves to enter the data, as long as the billing practitioner reviews and verifies the documentation.

3. Reconcile other navigation and care-management claims

1. Confirm the initiating visit, current consent and qualifying condition.
2. Verify the assigned personnel and their applicable requirements.
3. Review monthly activities and time against the plan of care.
4. Check for duplicate conditions, practitioners or time in other proposed services.
5. Have the billing practitioner review and verify the documentation before submission.

PIN may accompany CCM or PCM when each service’s requirements are met, services are reasonable and necessary, and time and effort are not counted twice. CMS also permits PIN alongside APCM; that permission does not eliminate the PIN service requirements.

PIN billing misreadings to resolve

PIN may be furnished using telecommunications technology. CMS treats it as ordinarily outside face-to-face care and outside the Medicare telehealth-services category, rather than adding it to the Telehealth Services List.

Do not infer a same-practitioner PIN-and-CHI combination from the general permission to furnish navigation alongside other care management. Confirm that specific scenario with the MAC; this article does not assert an unverified same-month combination.

Keep peer-support codes separate from general PIN when selecting the service. Their behavioral-health focus and specific personnel requirements make them more than alternative labels for the same navigation task.

Map the practitioner and staffing responsibilities

A practice evaluating principal illness navigation services should confirm who furnishes the initiating visit, obtains PIN consent and reviews the monthly records. Verify personnel requirements directly; 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.” PIN consent is obtained by the billing practitioner.

Key takeaways

• G0023 describes 60 minutes per calendar month of qualifying PIN.
• G0024 is the additional 30-minute code paired with the PIN base.
• The billing practitioner obtains documented PIN consent, including annual renewal.
• A new initiating visit is required each year for continuing PIN.
• One practitioner cannot report separate PIN services for multiple conditions in the same patient.

Frequently asked questions about g0023

Is G0023 a CPT code or an HCPCS code?

G0023 is an HCPCS code for principal illness navigation. G0024 describes additional monthly PIN time and is reported with the base service.

Can an annual wellness visit initiate PIN for a qualifying illness?

Yes, if the practitioner who will furnish and bill PIN performs the visit and identifies a qualifying high-risk condition. An annual wellness visit furnished by another person does not automatically satisfy that requirement.

Who must obtain consent for the PIN base service?

The billing practitioner obtains PIN consent before or when services begin. It may be written or verbal, must be documented and is renewed annually or when the billing practitioner changes.

Can one practitioner report two PIN services for two diagnoses?

No, CMS says one practitioner cannot bill PIN for multiple conditions for the same patient. Multiple concurrent PIN services require different conditions and different practitioners.

Must auxiliary personnel enter their own PIN notes?

CMS does not require auxiliary personnel to enter the record themselves. The billing practitioner must review and verify the documentation of time and activities related to the plan.

Does PIN end automatically after a fixed number of months?

CMS has not limited the duration of PIN. Continuing care requires a new initiating visit once each year and the other applicable service requirements.

Medicare Part B principal illness navigation uses HCPCS G0023 and G0024 for qualifying navigation under a billing practitioner’s direction in physician practices. Companian: “Your team refers; we handle enrollment, outreach and documentation. You bill monthly under your license.”

Read more: CHI code requirements · Medicare advocacy terminology

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.