What does Community Health Integration pay in 2026?
| Code | What it covers | CY2026 national non-facility |
|---|---|---|
| G0019 | first 60 min / month, auxiliary personnel | $86.17 |
| G0022 | each added 30 min, max 4 units | $54.11 |
National averages from our verified CY2026 fee-schedule config (source: CMS Physician Fee Schedule). Actual payment varies by locality, payer, and site of service.
Who can bill it?
Physicians and NP/PA practitioners bill it — and behavioral-health clinicians (psychologists, LCSWs, counselors, MFTs) can bill it for behavioral-health conditions.
Community health workers and similar auxiliary personnel furnish the time under the billing practitioner's general supervision — the CHW doesn't need to be in the same building.
One practitioner bills CHI for the patient in a given month, and the practice attests to its personnel's training and role before the first claim.
What are the minute thresholds?
- 60 minutes of auxiliary-personnel time in the calendar month opens G0019.
- Each added 30 minutes bills a G0022 unit, capped at 4 units (verified against the current NCCI MUE table).
- Minutes count once, and only US-furnished time counts toward the threshold.
What has to be in place first?
- An unmet upstream driver, documented at an initiating visit
- The billing practitioner documents the unmet upstream driver of health — CMS's CY2026 term replacing 'SDOH' — at an initiating visit before CHI months can bill.
- Personnel certification attestation
- The practice attests that the community health workers furnishing time meet the training and role requirements — once, before the first claim.
- Consent and enrollment
- Documented consent (with single-biller disclosure) and program enrollment, like every monthly family.
- Condition scope for BH clinicians
- When a psychologist, LCSW, counselor, or MFT is the billing practitioner, the qualifying condition must be a behavioral-health condition within their scope.
What gets claims denied?
- Commercial payers that never adopted it
- G0019/G0022 are Medicare-first codes from 2024. Commercial payers that haven't loaded them return CO-181-class denials — verify adoption before projecting beyond Medicare.
- Add-on units past the cap
- More than 4 G0022 units exceeds the NCCI MUE and denies.
- No documented upstream driver
- CHI months without the initiating-visit documentation of the unmet need aren't billable — the documentation is the program's foundation, not garnish.
- Stale 'SDOH' framing
- CY2026 finalized 'upstream driver(s)' as the operative terminology in the descriptor. The functional gate is unchanged, but documentation should use the current language.
What could this look like for your panel?
Estimates only, not billing advice. Actual Medicare reimbursement varies by region, payer, and year. Figures approximate CY2026 national non-facility averages from our verified fee-schedule config.
Frequently asked questions
- What do community health workers actually bill for?
- Time spent addressing the documented upstream driver — arranging transportation to appointments, navigating housing or food programs, connecting the person to community resources — under the billing practitioner's general supervision.
- Can an LCSW or counselor bill CHI?
- Yes, for behavioral-health conditions within their scope — 2026 policy lets BH clinicians bill the navigation families for the conditions they treat.
- How new are these codes?
- CHI arrived in 2024 — the first Medicare codes paying directly for community-health-worker time. Commercial adoption is still uneven, which is the main billing risk.
- What's the difference between CHI and PIN?
- CHI addresses upstream drivers of health interfering with any treatment plan; PIN (Principal Illness Navigation) navigates a specific serious, high-risk illness. Same structure, different qualifying need.
This page is general information, not billing, coding, or legal advice. Verify current requirements with the relevant payer before billing. Mallowa helps practices capture and document coordination time and generates claim-ready superbills; it does not submit claims or determine eligibility.