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G0019
Description, Billing Rules, and Use Cases

HCPCS G0019 is a monthly care coordination code for Community Health Integration (CHI) services delivered by certified or trained auxiliary personnel (such as community health workers) under the supervision of a physician or other practitioner.

 

It represents the first 60 minutes per calendar month spent addressing a patient's SDOH-related barriers to diagnosis or treatment.

What is HCPCS Code G0019?

G0019 was introduced by CMS to recognize the non-clinical but medically essential work performed by auxiliary staff when patients face barriers like food insecurity, unstable housing, transportation issues, or limited access to care. These SDOH needs must be significantly interfering with the practitioner’s ability to treat problems identified in an initiating visit.

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The scope of G0019 includes:

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  • Person-centered assessments to understand the patient’s social and cultural context

  • Goal-setting and action plan development aligned with treatment goals

  • Coordinating access to community and healthcare services (e.g., food assistance, shelters, PCP referrals)

  • Educating patients about navigating the health system

  • Promoting behavior change and building self-advocacy skills

  • Helping patients with emotional and social support through change

  • Leveraging lived experience of the auxiliary staff, when applicable

 

G0019 represents the first 60 minutes of CHI services in a calendar month. For each additional 30 minutes, see G0022.

G0019 Billing Requirements and Eligibility

To bill G0019, the following core conditions must be met. These ensure that the Community Health Integration (CHI) services are structured, clinically relevant, and compliant with CMS guidance.

Patient Eligibility Criteria

To qualify for G0019:

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  • The patient must have one or more clinical conditions that require treatment or management

  • The patient must face documented social determinants of health (SDOH) that interfere with diagnosis or care

  • An initiating visit with a billing practitioner must occur before or on the same date as CHI services begin

    • Examples include E/M visits, Annual Wellness Visits, Transitional Care Management, or behavioral health evaluations

Who May Deliver the Service

G0019 services must be:

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  • Personally provided by auxiliary personnel under general supervision of the billing practitioner

  • Auxiliary personnel may include:

    • Community health workers

    • Peer support specialists

    • Certified health educators or lay navigators with appropriate training

  • The practitioner does not need to be present during service delivery but must be available for supervision and billing

Supervising Provider and Setting

The billing provider must be:

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  • A physician, nurse practitioner, clinical nurse specialist, or physician assistant

  • Enrolled in Medicare and supervising within their scope of practice

  • The service must be billed from:

    • Physician offices or outpatient settings (POS 11 or equivalent)

    • Not payable in inpatient, SNF, or hospice facilities

Service Requirements and Documentation

To bill G0019:

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  • At least 60 minutes of CHI services must be documented within a calendar month

  • Services must be individualized and goal-driven, aligned with the patient’s care plan

  • The documentation must include:

    • Specific SDOH barriers being addressed

    • Description of care coordination or resource access activities

    • Communication with the supervising practitioner as needed

    • Logs of staff activity, interactions, and time spent

G0019 Billing Documentation Checklist

To compliantly bill G0019, ensure the following elements are present in the patient’s record:

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  • Initiating Visit Record:

    • Document the type and date of the initiating visit (e.g., E/M, AWV, behavioral health assessment)

    • Ensure it occurred on or before the first date of CHI services in the billing period

  • Patient eligibility and social context:

    • Identify one or more clinical conditions requiring treatment

    • Document the specific SDOH barrier(s) interfering with diagnosis or care (e.g., housing instability, food insecurity, transportation access)

  • Auxiliary personnel details:

    • Name, title, and training credentials of the community health worker or auxiliary staff

    • Statement that services were provided under general supervision of the billing practitioner

    • Provider’s name and role noted as supervising entity

  • Service log or care interaction summary:

    • Dated notes describing the CHI services delivered (e.g., needs assessments, referrals, coaching)

    • Activities linked to patient goals or care plan

    • Details of education, emotional support, advocacy, or community navigation provided

    • If multiple staff members contributed, time should be tallied separately

  • Total time spent:

    • Documentation of at least 60 minutes of CHI services in the billing month

    • May be cumulative, but must reflect only direct service time (not admin or idle time)

    • Time log or attestations included in the record

  • Care plan linkage:

    • Notes show how the services support or align with the patient’s medical treatment plan

    • Any feedback or escalations to the supervising practitioner noted

  • Place of service and setting validation:

    • Must occur in an outpatient or physician office setting

    • Not billable in facility, inpatient, SNF, or hospice environments

G0019 Time Thresholds and Code Combinations

G0019 is billed for the first 60 minutes of Community Health Integration (CHI) services delivered in a calendar month. Additional time may be reported using G0022, but only when all thresholds and documentation are met.

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Use the following chart to determine the correct billing combination:

Table showing G0019 time-based billing logic, monthly thresholds, and pairing with G0022 under CMS supervision rules.

Key Reminders:

  • G0019 is limited to once per calendar month per patient

  • The minimum required time is 60 minutes of direct CHI services

  • Additional time may be reported with G0022 (per 30 minutes)

  • All time must be personally performed by auxiliary personnel under general supervision

When to Use G0019:
Common Scenarios and Use Cases

G0019 should be billed when at least 60 minutes of Community Health Integration (CHI) services are provided in a calendar month by auxiliary personnel under general supervision. Services must address documented social determinants of health (SDOH) that interfere with medical care.

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Here are examples of how G0019 is used in practice:

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  • Addressing Food Insecurity in Diabetes Management
    A community health worker (CHW) under physician supervision:

    • Identifies food insecurity during intake assessment

    • Connects the patient to local SNAP resources and food banks

    • Provides coaching on blood sugar-friendly food options based on budget

    • Tracks follow-through and notifies the supervising physician
      Total qualifying time: 65 minutes
      Billing: G0019

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  • Coordinating Care for Unstable Housing and Hypertension
    An auxiliary care navigator (under PA supervision):

    • Assesses SDOH and discovers patient is couch-surfing

    • Arranges a referral to a housing stabilization nonprofit

    • Helps the patient obtain a blood pressure monitor from a local DME vendor

    • Reviews the patient's goals and logs barriers in the EHR
      Total qualifying time: 82 minutes
      Billing: G0019

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  • Language Barrier and Medicaid Re-enrollment Support
    A bilingual peer support specialist (under NP supervision):

    • Aids a Spanish-speaking patient in updating Medicaid eligibility to resume behavioral health services

    • Teaches the patient how to access a telehealth portal and request transportation

    • Escalates a lapse in prescriptions to the supervising NP
      Total qualifying time: 75 minutes
      Billing: G0019

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  • Culturally Matched Coaching for Obesity and Social Isolation
    A trained lay navigator with lived experience (under MD supervision):

    • Works with a patient on accessing group wellness programs in their community

    • Supports the patient in addressing transportation anxiety and mistrust of medical settings

    • Uses motivational interviewing techniques to develop a social support plan
      Total qualifying time: 90 minutes
      Billing: G0019 + G0022

Common G0019 Billing Mistakes
(and How to Avoid Them)

G0019 introduces a new billing pathway for non-clinical, SDOH-driven services — but its novelty means errors are likely, especially around time tracking, supervision, and scope.​

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  • ❌ Billing Without an Initiating Visit
    G0019 must be tied to an initiating visit (e.g., E/M, AWV, behavioral health assessment). If this visit is missing or not properly linked in the record, claims will be denied.
     

  • ❌ Fewer Than 60 Minutes of Documented CHI Time
    This code requires a minimum of 60 minutes per calendar month. Logging 59 minutes — even with excellent documentation — does not qualify.
     

  • ❌ Time Not Provided by Qualified Auxiliary Staff
    G0019 requires services to be delivered by trained or certified personnel (e.g., CHWs, lay navigators, peer support specialists). Time logged by front office staff or untrained workers does not qualify.
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  • ❌ Supervising Practitioner Not Documented or Enrolled​
    ​The supervising provider must:

    • Be a physician or QHP enrolled in Medicare

    • Be clearly identified in documentation

    • Provide general supervision (available, not necessarily present)

  • Failure to document this link may invalidate the claim.

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  • ❌ Billing G0019 Twice in the Same Month
    G0019 is limited to once per patient, per calendar month. Attempting to bill it more than once — even with distinct sessions — is not permitted. Additional time should be reported with G0022.

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