Principal illness navigation services help patients with serious, high-risk conditions stay connected to their treatment plan. The Centers for Medicare & Medicaid Services (CMS) created PIN services in the calendar year 2024 Physician Fee Schedule to pay for navigation work that care teams were already doing. A trained navigator or certified peer specialist works with the patient by phone, by message, and in person. The navigator’s job is to remove the practical obstacles that sit between a patient and their care.
Two code families describe this work. Two codes cover general principal illness navigation services. Two more cover Principal Illness Navigation-Peer Support, known as PIN-PS, for patients with behavioral health conditions. All four are furnished by certified or trained auxiliary personnel under the general supervision of a billing practitioner.
The design of PIN services reflects a simple clinical reality. A new diagnosis of cancer or heart failure brings appointments, referrals, medications, and paperwork all at once. Patients who lose track of any one of those things tend to fall out of treatment. Navigation keeps them in it.
Who Qualifies for PIN Services
A patient qualifies when a clinician identifies a serious, high-risk condition expected to last at least three months. The condition must place the patient at significant risk of one of the following:
- Hospitalization
- Nursing home placement
- Acute exacerbation or decompensation
- Functional decline or death
CMS does not publish a closed list of qualifying diagnoses. The definition rests on the treating practitioner’s clinical judgment. Conditions commonly navigated under PIN include cancer, chronic obstructive pulmonary disease (COPD), congestive heart failure, dementia, Parkinson’s disease, HIV/AIDS, severe mental illness, and substance use disorder.
CMS offers additional parameters that help qualify a condition. The condition may require development, monitoring, or revision of a disease-specific care plan. It may require frequent adjustments to the medication or care regimen. It may also require substantial assistance from a caregiver.
PIN-PS applies the same three-month standard to serious, high-risk behavioral health conditions. Peer support specialists and peer recovery coaches deliver this track. Their lived experience is part of what makes the support work.
Two requirements sit in front of every PIN claim. First, the patient needs an initiating visit with the billing practitioner. During that visit, the practitioner establishes medical necessity, sets the treatment plan, and orders navigation. According to the National Association of Community Health Centers, an Initial Preventive Physical Exam does not count as an initiating visit for PIN. Second, the patient must consent. Consent may be verbal or written, must be documented in the record, and must be obtained again each year.
What Changed for PIN Services in 2026
PIN is no longer a brand-new benefit. Three years of rulemaking have clarified how it works and who can deliver it.
The CY 2026 Physician Fee Schedule final rule confirmed that marriage and family therapists and mental health counselors may bill for principal illness navigation services they personally perform for the diagnosis or treatment of mental illness. CMS also clarified that the billing practitioner does not have to be the clinician who made the mental health diagnosis. Both changes widen the set of practices that can offer navigation to behavioral health patients.
CMS also retired the phrase “social determinants of health” from this family of services. The agency now uses “upstream drivers” of health instead. It kept HCPCS code G0136 and revised the descriptor to cover assessment of physical activity and nutrition. The shift in language matters for documentation templates and staff training more than for eligibility.
Federally qualified health centers and rural health clinics have their own timeline. Since January 1, 2025, these centers bill care management services using individual codes rather than the bundled G0511 code. Starting January 1, 2026, they can also bill optional add-on codes for advanced primary care management that support behavioral health integration. For centers running navigation alongside monitoring, that gives the care plan more room to match patient acuity.
The Core Elements of Principal Illness Navigation
CMS built the PIN code descriptors around a defined set of activities. A navigator documents these as the month’s work:
- Person-Centered Assessment. The navigator learns the patient’s history, strengths, goals, and preferences, including cultural and linguistic factors and any unmet upstream needs.
- Goal Setting and Action Planning. The patient drives the goals. The navigator turns them into steps the patient can actually take.
- Care Coordination. The navigator coordinates services across practitioners and community organizations and helps the patient move between settings of care.
- Health Education. Patients and caregivers get education tailored to the condition so they can take part in decisions about treatment.
- Self-Advocacy Skills. The navigator teaches the patient how to ask questions, request records, and work with their care team directly.
- Social and Emotional Support. Patients get help coping with the condition and adjusting daily routines to fit treatment.
- Peer Support. Under PIN-PS, a certified peer specialist adds mentorship grounded in shared experience.
The American Psychological Association publishes a clinical example of how these activities map to a single patient month, which is a useful reference when writing documentation templates.
PIN Billing Codes and Documentation Requirements
Four HCPCS codes describe principal illness navigation services. Each is billed once per calendar month based on documented time.
| Code | What it describes |
|---|---|
| G0023 | Principal illness navigation services by certified or trained auxiliary personnel under the direction of a physician or other practitioner, including a patient navigator; 60 minutes per calendar month |
| G0024 | Principal illness navigation services, each additional 30 minutes per calendar month, listed separately from G0023 |
| G0140 | Principal Illness Navigation-Peer Support by certified or trained auxiliary personnel under the direction of a physician or other practitioner, including a certified peer specialist; 60 minutes per calendar month |
| G0146 | Principal Illness Navigation-Peer Support, each additional 30 minutes per calendar month, listed separately from G0140 |
This material is provided for general informational and educational purposes only and does not constitute legal, compliance, billing, coding, or reimbursement advice. CPT® codes, descriptions, and Medicare payment rates referenced here are drawn from publicly available sources, are subject to change, and may vary by payer, locality, and patient circumstances. Tenovi makes no representation or guarantee regarding coverage, payment, or the appropriateness of any code for a particular patient or service, and any presented are illustrative only. Providers are solely responsible for independently determining medical necessity and applicable coding, coverage, documentation, and billing requirements and for submitting accurate claims. Consult applicable payer guidance and qualified billing, coding, compliance, or legal professionals before making billing decisions. CPT® is a registered trademark of the American Medical Association.
Payment amounts are set in the annual Physician Fee Schedule. They change every year and vary by geographic locality, so billing teams should check the current fee schedule for their region rather than working from a figure published in an earlier year.
A few operational rules shape how these codes are used:
- Only one practitioner bills PIN for a given patient in a given month.
- Time counted toward PIN cannot be counted again toward another service.
- The auxiliary personnel delivering the service must meet applicable licensure, certification, and training requirements. The billing practitioner is responsible for confirming that.
- Standard Part B cost sharing applies, so the consent conversation should cover what the patient may owe.
Practices that already run care management should also confirm how PIN sits alongside their existing programs. PIN may be billed in the same month as advanced primary care management, community health integration, and remote monitoring. Chronic care management and principal care management follow their own overlap rules, and those rules are the ones most likely to trigger a denial.
How PIN Services and Remote Patient Monitoring Work Together
Navigation answers the question of what a patient needs. Remote monitoring answers the question of how that patient is doing right now. Together they give a care team both halves of the picture.
A patient with congestive heart failure offers the clearest example. Daily weight and blood pressure readings show the care team when fluid is building up. The navigator is the person who acts on that signal, calling the patient, arranging the appointment, and sorting out the transportation that would otherwise cause a missed visit. The reading creates the prompt. The navigator closes the loop.
The 2026 fee schedule made this pairing easier to sustain. CMS added shorter-duration monitoring codes for patients who transmit fewer days of data or need less management time each month, alongside the existing RPM CPT codes. Programs no longer have to drop a patient who engages inconsistently.
The documentation discipline is straightforward. Monitoring time and navigation time are logged separately, and no minute is counted twice. A navigator who spends 20 minutes reviewing readings and 40 minutes arranging a specialist referral records those blocks as two distinct entries.
For the patient, none of this shows up as separate programs. One person calls, knows their history, and helps. That is the point.
Putting PIN Services Into Practice
Care teams that run navigation well tend to start in the same place.
Begin by identifying the patients. Pull a list of patients with serious conditions who have missed appointments, cycled through the emergency department, or fallen behind on medications. Those patients are usually the ones navigation helps most.
Next, define who does the work. Some practices train existing staff, including community health workers and medical assistants. Others hire dedicated navigators or contract with a partner. For PIN-PS, look for certified peer specialists with training that matches the condition.
Then build the documentation into the workflow rather than around it. Consent, the initiating visit, the care plan, and monthly time logs all need a place in the chart where staff can find them. Annual consent renewal is easy to miss, so put it on a calendar.
Finally, connect navigation to the data the care team already receives. Remote patient monitoring, lab results, and admission alerts all give navigators a reason to call before a patient’s condition worsens.
Frequently Asked Questions
1) What are principal illness navigation services?
Principal illness navigation services are Medicare-covered support services for patients with serious, high-risk conditions. A trained navigator or certified peer specialist helps the patient understand their condition, coordinate care across providers, and clear the practical obstacles that interrupt treatment. The work is performed by auxiliary personnel under the general supervision of a billing practitioner.
2) What conditions qualify a patient for PIN services?
Any serious, high-risk condition expected to last at least three months can qualify when it puts the patient at significant risk of hospitalization, nursing home placement, acute decompensation, functional decline, or death. Cancer, COPD, congestive heart failure, dementia, HIV/AIDS, severe mental illness, and substance use disorder are common examples. The treating practitioner makes the determination.
3) What is the difference between PIN and PIN-PS?
PIN covers navigation for medical and behavioral high-risk conditions and is delivered by personnel such as patient navigators or community health workers. PIN-PS covers peer support for patients with serious behavioral health conditions and is delivered by certified peer specialists. The two tracks use separate codes.
4) Does a patient need a visit before PIN services can begin?
Yes. An initiating visit with the billing practitioner is required before navigation starts. During that visit the practitioner establishes medical necessity, creates the treatment plan, and orders the service. An Initial Preventive Physical Exam does not satisfy this requirement.
5) Can PIN services be billed with remote patient monitoring?
Yes. Principal illness navigation and remote patient monitoring may be furnished in the same month for the same patient. The time spent on each must be documented separately and cannot be counted twice. Practices should also confirm overlap rules for chronic care management and principal care management.
6) Who can deliver and bill for PIN services?
Certified or trained auxiliary personnel deliver the service under the general supervision of a physician or other billing practitioner. As of the CY 2026 final rule, marriage and family therapists and mental health counselors may bill for PIN services they personally perform for the diagnosis or treatment of mental illness.
Understanding Principal Illness Navigation Services
Principal illness navigation services exist because a treatment plan only works if the patient can follow it. CMS built PIN and PIN-PS around the activities that keep patients in care, including person-centered assessment, care coordination, health education, self-advocacy, and social and emotional support. Eligibility rests on a serious, high-risk condition expected to last at least three months, an initiating visit, and documented annual consent. The four codes, G0023, G0024, G0140, and G0146, describe monthly navigation time delivered by trained auxiliary personnel or certified peer specialists. The 2026 fee schedule widened who can bill for this work and gave remote monitoring programs more flexibility to serve patients with varying levels of engagement. Used together, navigation and monitoring let care teams reach patients earlier, when a phone call still solves the problem.
Tenovi provides cellular-connected remote patient monitoring and remote therapeutic monitoring devices and infrastructure to the software companies, care management organizations, and health systems that serve these patients. Our Tenovi Gateway connects devices without WiFi, Bluetooth pairing, or a smartphone, so patients can start taking readings on day one. To see how monitoring data can support your navigation and care management programs, book a free demo and consultation with our team.
