New Medicare codes could transform how physicians serve their most vulnerable patients — here’s how to use them

For most practices, the 2024 Medicare Physician Fee Schedule update came and went without much fanfare. But buried in that rule and further refined in the 2026 update are two billing codes that represent one of the most significant expansions in decades of what Medicare will pay for: community health integration (CHI) and principal illness navigation (PIN).

Despite being active since January 2024, these codes remain widely underutilized. The reasons are well documented. A 2025 national implementation analysis by Freedmen’s Health Consulting, which has supported CHI and PIN rollout across dozens of state and local markets, has found that role confusion, consent and patient communication, clinical integration challenges and information technology barriers are the most common obstacles preventing physician practices from activating these services.

In short, most practices know the codes exist. They just do not know how to turn them on. That gap represents both a care quality problem and a missed revenue opportunity, and the 2026 Physician Fee Schedule final rule makes it more urgent to address.

What CHI and PIN actually are

CHI, billed under HCPCS code G0019, covers 60 minutes of services per calendar month delivered by certified or trained auxiliary personnel under the general supervision of a billing physician. The services address what CMS now formally calls “upstream drivers,” a term introduced in the 2026 rule to replace “social determinants of health.” These are factors such as housing instability, food insecurity, transportation barriers and financial constraints that directly limit a physician’s ability to diagnose or treat the patient sitting in front of them. A 2022 study published in Health Affairs examining 68,000 Medicare Advantage participants found that 33% experienced financial strain, 18.5% experienced food insecurity, and 17.7% had poor housing quality. These are not peripheral issues. They are clinical barriers showing up in exam rooms every day, and until recently, physicians had no reimbursement pathway to address them systematically.

PIN, billed under G0022 and G0023, functions similarly but targets patients with serious high-risk conditions like cancer, heart failure and chronic kidney disease who need dedicated navigation support to stay engaged in their care plans and avoid preventable hospitalizations.

Both codes require an initiating visit to activate. Under the 2026 rule, that list of qualifying initiating visits expanded to include Psychiatric Diagnostic Evaluations and Health Behavior Assessment and Intervention codes, giving more physicians across more specialties a pathway to begin these services for their patients.

Who can deliver these services?

This is where many physicians get stuck, and where the 2026 rule provides important clarification. CHI and PIN services are delivered by auxiliary personnel under the billing physician’s general supervision, meaning the physician does not need to be present during the service. CMS has confirmed that auxiliary personnel are not limited to community health workers. Registered nurses, clinical social workers, licensed professional counselors, marriage and family therapists, and mental health counselors all qualify, provided they meet the competency requirements outlined in the code definitions. Those competencies include patient and family communication, interpersonal and relationship-building skills, service coordination and system navigation, patient advocacy, and development of an appropriate knowledge base, including local community-based resources.

This flexibility matters because it means physician practices are not required to hire and train a community health worker from scratch. A qualified contractor or care coordination organization that already employs trained auxiliary personnel can deliver these services under the physician’s supervision, with the physician billing the applicable G-codes and compensating the contractor from the reimbursement received.

What the reimbursement looks like in practice

The base CHI code G0019 covers the first 60 minutes of service per calendar month. Add-on codes allow for additional time beyond that initial hour when medically necessary. PIN codes follow a similar structure. For context on the financial impact, consider the Medicare Savings Program enrollment gap. A 2023 study published in JAMA Network Open found that only 56.7% of eligible Medicare beneficiaries are enrolled in the Medicare Savings Program, which eliminates most cost-sharing for qualified Medicare beneficiaries. Helping a panel of patients close that gap, a direct CHI service activity reduces financial barriers to care adherence while generating legitimate reimbursement for the practice delivering the intervention. Multiply that across a patient panel in which one-third of patients experience financial strain, and the clinical and financial case for implementation becomes difficult to ignore.

What to expect for revenue

The numbers are straightforward. G0019 reimburses approximately $79 per patient per month at the nonfacility rate for the initial 60 minutes of CHI service. Each additional 30-minute increment under G0022 is reimbursed at approximately $49. PIN services under G0023 follow a similar structure. For a practice with a Medicare patient panel where even 20% of patients qualify and enroll, the monthly reimbursement from CHI and PIN alone represents a meaningful and recurring revenue stream generated entirely from serving patients the practice is already seeing for needs the practice is already aware of but currently has no payment pathway to address.

The implementation barrier physicians need to solve first

The single most common implementation failure identified across markets is not billing or coding. It is, specifically, clinical integration: the absence of a clear workflow that connects the physician’s initiating visit to the auxiliary personnel delivering the service and back to the physician’s care plan. The solution is straightforward in principle. The physician conducts a qualifying initiating visit, identifies an upstream driver limiting the patient’s care and refers the patient to the auxiliary personnel responsible for CHI or PIN delivery. That person delivers the service, documents their time and interventions, and communicates back to the physician. The physician bills the applicable code. What makes this difficult in practice is that most practices were not built with this workflow in mind. Building it requires role clarity, documentation infrastructure, and a reliable auxiliary personnel resource, either hired in-house or contracted externally. The 2026 rule does not change that operational reality. But it clearly signals that CMS intends for these services to become a standard part of how Medicare patients are managed in primary care. Practices that build the infrastructure now will be positioned ahead of those who wait.

The window is open

Independent family practice and internal medicine physicians are exactly the practitioners CMS designed these codes for. The patient population is there. The reimbursement pathway is there. The 2026 rule has expanded the options for initiating visits and clarified the requirements for auxiliary personnel, removing two of the most common barriers to getting started. What remains is the operational decision to build the workflow, identify qualified auxiliary personnel and activate the codes for the patients who need these services most.

Rachel Yates, B.S.N., RN, is the founder and CEO of Premier Care Coordination LLC, a nurse-led virtual care coordination and patient advocacy company based in Indiana serving clients nationwide. Premier Care Coordination specializes in CHI and PIN service delivery as contracted auxiliary personnel for Medicare-billing physicians.