Effective January 1, 2024, CMS launched new HCPCS codes for Principal Illness Navigation (PIN) and Community Health Integration (CHI) services. This coverage is intended to support patients with serious conditions navigate their health care treatment and address unmet social needs that may impact health incomes.
Major private issuers (BCBS, Aetna, Cigna, United Health, and others) have committed to supporting Navigation by also reimbursing these codes. Equicare users are already receiving monthly reimbursement for these codes through NAV+ automated tools.
PIN Program criteria
Criteria | Principal Illness Navigation | Community Health Integration |
---|---|---|
Intake | High risk condition expected to last at least three months | SDOH(s) suspected with an anticipated impact on treatment plan |
Initiating Patient Visit | Required | Required |
Directive for Care | Documented by billing practitioner in medical record | Documentation in treatment plan of how addressing SDOH(s) are expected to help with diagnosis and treatment |
Consent | Verbal or written consent, obtained annually | Verbal or written consent, obtained once only unless a change in billing practitioner |
Additional Criteria | Services to be provided by licensed health care professionals and/or certified or trained auxiliary personnel (e.g. Community Health Workers, Peer Support Navigators) Reimbursement requires a program to track, audit, and bill for PIN and CHI services |
NAV+ was designed to meet the PIN, CHI, and PCM* program requirements and enable you to immediately receive reimbursement of services provided under the program.
(*PCM – Primary Care Management)