What does Principal Illness Navigation pay in 2026?
| Code | What it covers | CY2026 national non-facility |
|---|---|---|
| G0023 | first 60 min / month, navigator | $87.18 |
| G0024 | each added 30 min, max 4 units | $54.44 |
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 — and behavioral-health clinicians for behavioral-health conditions (serious mental illness is an explicitly qualifying category).
Trained patient navigators furnish the time under general supervision.
One practitioner bills PIN per CONDITION per month. Two practitioners can each bill PIN for the same patient in the same month when each navigates a different documented condition.
What are the minute thresholds?
- 60 minutes of navigator time in the calendar month opens G0023.
- Each added 30 minutes bills a G0024 unit, capped at 4 units (current NCCI MUE).
- Minutes count once, per condition — a navigator's hour on the cancer plan doesn't fund a second claim on the cardiac plan.
What has to be in place first?
- A serious, high-risk condition
- The navigated illness must be serious and high-risk — expected to last months, with risk of hospitalization, decompensation, or death. Serious mental illness qualifies explicitly.
- A condition documented on the enrollment
- PIN billing is scoped per condition, so the enrollment must carry the qualifying-condition documentation — it's what lets two practitioners bill different conditions cleanly.
- Personnel certification attestation
- The practice attests its navigators meet the training requirements before the first claim.
- Consent, enrollment, and condition scope
- Documented consent and enrollment; BH clinicians bill only for behavioral-health conditions within their scope.
What gets claims denied?
- Two claims, one condition
- Per-condition means per-condition: two practitioners billing PIN for the same illness in the same month is a duplicate, and the later claim denies.
- Missing condition documentation
- A PIN claim without the qualifying condition documented on the enrollment can't demonstrate its own scope — hold until the documentation exists.
- Commercial payers that never adopted it
- Like CHI, these are Medicare-first 2024 codes — expect CO-181-class denials from payers that haven't loaded them.
- Add-on units past the cap
- More than 4 G0024 units exceeds the NCCI MUE.
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 conditions qualify for PIN?
- Serious, high-risk conditions expected to last months and carrying real risk of hospitalization or worse — cancers, serious mental illness, and comparable illnesses. The judgment is clinical, documented on the enrollment.
- Can two specialists both bill PIN for one patient?
- Yes — in the same month, each for a different documented condition. The oncology navigator and the behavioral-health navigator can each bill their own program.
- Who counts as a navigator?
- Trained auxiliary personnel meeting CMS's navigation-training requirements, furnishing time under the billing practitioner's general supervision — the practice attests to this before billing.
- How does PIN differ from PIN Peer Support?
- Same structure, different workforce: PIN uses trained navigators; PIN-PS (G0140/G0146) uses certified peer-support specialists, for behavioral-health conditions where lived experience is the qualification.
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.