G0023 Description, Billing Rules, & Use Cases
Principal Illness Navigation (PIN) Services – Description, Billing, and Use Cases
HCPCS code G0023 is used to report Principal Illness Navigation (PIN) services delivered by certified or trained auxiliary personnel, such as patient navigators, under the direction of a billing physician or practitioner. The service supports patients with serious, high-risk, or complex chronic conditions who need help navigating their care, accessing services, and overcoming barriers to treatment.
G0023 captures the first 60 minutes per calendar month of in-person and community-based activities designed to improve care coordination, patient understanding, and adherence to diagnosis and treatment goals.
What is HCPCS Code G0023?
G0023 represents a set of non-clinical but high-touch support services furnished under general supervision by auxiliary staff. These services focus on helping patients follow through on care plans, connect to needed resources, and manage the impact of social determinants of health (SDOH).
PIN services are distinct from Chronic Care Management (CCM) in that they do not require complex medical management or time-based tracking of provider work. Instead, they are navigation- and engagement-focused, especially for patients who need more hands-on support navigating a fragmented system.
Key elements of the G0023 service include:
- 60 minutes of service per calendar month, delivered by certified or trained auxiliary personnel
- Must be performed under the direction of a billing practitioner
- Services may include:
- Person-centered assessment (goals, cultural and linguistic factors, unmet SDOH needs)
- Tailored goal setting and action planning
- Facilitating access to practitioners, specialists, or social services
- Coordination of transitions (e.g., post-hospital discharge)
- Supporting behavioral change and patient activation
- Providing social or emotional support, when appropriate
- Documented in the medical record at the billing provider’s office
- May be reported in addition to other care management codes, if services are distinct and not duplicative
G0023 Time Thresholds and Code Combinations
The following scenarios outline how to correctly report HCPCS code G0023 based on the total time spent providing Principal Illness Navigation (PIN) services within a single calendar month. Since G0023 covers the first 60 minutes, any additional time beyond that threshold should be billed using G0024 for each extra 30-minute increment. If G0023 is billed alongside other care management services—such as CCM or PCM—documentation must clearly demonstrate that the services are distinct, non-overlapping, and separately recorded to remain compliant with CMS guidelines.
Important to Note:
- Minimum threshold: Must document a full 60 minutes before reporting G0023.
- Add-on rules: Use G0024 for each additional 30 minutes in the same month.
- Distinct services: If combining with CCM, PCM, or CoCM codes, documentation must prove no duplication of effort.
- Supervision: Always general supervision — physician presence not required.
- MUE limit: 1 unit per calendar month for G0023; additional time requires G0024.
When to Use G0023: Common Scenarios and Use Cases
G0023 is used to report the first 60 minutes of Principal Illness Navigation (PIN) services provided by certified or trained auxiliary personnel under the general supervision of a billing physician or other qualified health care professional. These services help patients with serious, high-risk, or complex conditions navigate their care plans, access resources, and coordinate appointments. If additional time is required beyond the initial 60 minutes, report G0024 for each additional 30-minute increment within the same calendar month.
Post-Discharge Navigation for Heart Failure
A patient navigator (certified auxiliary personnel) under general supervision:
- Conducts a person-centered assessment and reviews discharge instructions with the patient and spouse
- Schedules cardiology and primary-care follow-ups and confirms appointment transportation
- Coordinates home-delivered medications and verifies cost/coverage barriers are addressed
- Aligns the action plan with the practitioner and documents all activities in the medical record
Total staff time (auxiliary personnel): 90 minutes
Billing: G0023 + G0024
COPD Access and Care Coordination
A patient navigator (certified auxiliary personnel) under general supervision:
- Performs a person-centered assessment to identify goals, literacy needs, and SDOH barriers
- Secures appointments with pulmonology and pulmonary rehab; coordinates home oxygen supplier
- Connects the patient to community transportation resources and smoking-cessation support
- Provides tailored education to improve adherence to the treatment plan and documents services
Total staff time (auxiliary personnel): 60 minutes
Billing: G0023
Dementia Caregiver Support and Specialist Coordination
A patient navigator (certified auxiliary personnel) under general supervision:
- Assesses patient and caregiver needs; captures cultural/linguistic preferences and safety concerns
- Coordinates neurology and primary-care visits; prepares the caregiver with what to bring/ask
- Connects the family to respite care and a local caregiver support group; reviews community resources
- Facilitates information exchange with the care team and records activities in the medical record
Total staff time (auxiliary personnel): 120 minutes
Billing: G0023 + 2×G0024
G0023 Billing Requirements and Eligibility
To compliantly report G0023, certified or trained auxiliary personnel must deliver at least 60 minutes of Principal Illness Navigation (PIN) services under the general supervision of a billing physician or qualified health care professional (QHP) within the same calendar month. If services exceed 60 minutes, report G0024 for each additional 30-minute increment of time. Documentation must clearly support patient eligibility, service duration, and coordination activities.
Patient Eligibility Criteria
- Must have a serious, high-risk, or complex condition (e.g., cancer, COPD, dementia, CHF, HIV/AIDS, severe mental illness, or SUD)
- Must require ongoing care coordination and navigation to manage treatment and access resources
- Services must involve a person-centered assessment addressing goals, preferences, and potential barriers (e.g., SDOH)
- Auxiliary personnel providing the service must be certified or trained and authorized under state law
Time and Service Threshold
- G0023 covers the first 60 minutes of PIN services delivered in a single calendar month
- Use G0024 to report each additional 30-minute increment of service time beyond the initial 60 minutes
- Services must be performed by certified or trained auxiliary personnel under the general supervision of the billing practitioner
- A minimum of 60 full minutes must be completed before reporting G0023 — partial time under the threshold cannot be billed
Documentation Requirements
The clinical record must reflect:
- Total cumulative time spent providing PIN services in the month
- Specific activities performed, including assessments, care coordination, patient education, and resource navigation
- Communication and coordination with the supervising practitioner and other members of the care team
- Patient goals, barriers addressed, and any modifications to the care plan
- The role and credentials of the auxiliary personnel delivering the services
Billing Limits and Combinations
- G0023 represents the first 60 minutes and can only be billed once per calendar month
- G0024 may be added for each additional 30-minute unit if time requirements are met
- May be reported in the same month as Chronic Care Management (CCM), Principal Care Management (PCM), or other care coordination codes only if:
- Services are distinct and non-overlapping
- Documentation separately supports each activity
- Do not round up time if the minimum threshold for a unit is not met
- Cannot be billed if less than 60 minutes of service is delivered in the month
G0023 Billing Documentation Checklist
To compliantly bill G0023, the following must be clearly documented in the patient’s chart:
- Confirmation that at least 60 minutes of eligible PIN services were provided in the same calendar month
- Use of G0024 for each additional 30-minute increment beyond the initial 60 minutes
- Description of the services performed, which may include:
- Person-centered assessments
- Appointment scheduling and care plan review
- Coordination with specialists, hospitals, or community resources
- Addressing social determinants of health (e.g., housing, transportation)
- Patient and caregiver education
- Communication and alignment with the supervising physician or QHP
- Credentials and role of auxiliary personnel delivering services
- Documentation showing that services build upon ongoing care coordination goals
Common G0023 Billing Mistakes (and How to Avoid Them)
❌ Billing G0023 Without 60 Minutes of Documented Time
You must document at least 60 full minutes of Principal Illness Navigation (PIN) services before reporting G0023. Anything less is not billable under this code.
❌ Forgetting to Add G0024 for Additional Time
G0023 covers the first 60 minutes only. If auxiliary personnel deliver more than 60 minutes of services, you must bill G0024 for each additional 30-minute increment. Failing to add G0024 means leaving reimbursable time unclaimed — but billing it without meeting the time threshold will lead to denials.
❌ Counting Physician or QHP Time Toward the Threshold
G0023 and G0024 are reported for services provided by certified or trained auxiliary personnel only. Time spent by the billing provider does not count toward the required 60 minutes and must be billed under another applicable code if appropriate.
❌ Double Billing With CCM, PCM, or CoCM Codes
You may bill G0023 in the same month as other care management codes only if services are distinct and separately documented. Do not duplicate time or activities across codes. Examples include:
- 99490–99491 (Chronic Care Management)
- 99424–99427 (Principal Care Management)
- 99492–99494 (Collaborative Care Model)
- 99487–99489 (Complex CCM)
❌ Billing More Than One G0023 Unit Per Month
G0023 may be billed once per calendar month per patient. Even if your auxiliary personnel log more than 60 minutes, you cannot bill a second G0023 — instead, report G0024 for each additional 30-minute block.
❌ Missing Documentation of Care Coordination Activities
Incomplete documentation is one of the top denial triggers for G0023. Your patient record must include:
- Person-centered assessment details
- Activities performed (e.g., appointment scheduling, social service navigation, care coordination)
- Communication with the supervising practitioner
- Barriers addressed and patient/caregiver education provided
