Principal Illness Navigation
What it is
Principal Illness Navigation (PIN) is a CY 2024+ benefit for patients with a serious high-risk condition (e.g., cancer, advanced heart failure, ESRD, dementia) where navigation by a credentialed navigator improves outcomes.
Billed monthly in tiers similar to CCM.
Who qualifies
- The billing practitioner has seen the patient for an initiating visit (renewed every 12 months) and designated one serious, high-risk condition expected to last at least 3 months.
- Each navigator has a PIN qualification on file — the state's certification, or training in the seven CMS competencies — and the practitioner has confirmed they are trained on the patient's condition.
- Patient consent on file.
- Care plan addresses the serious illness, social drivers of health, and patient/caregiver education.
- Can be billed in the same month as CCM, PCM, APCM, BHI or CHI, even by the same practitioner; each logged minute counts toward one program only.
Codes & when to bill them
Each billable code, with the requirements that must be on file to bill it.
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G0023First 60 minutes of PIN time per calendar month, staff and practitioner combined.RequirementsInitiating visit within 12 months; designated serious condition; qualified navigator; consent within 12 months; 60+ min.
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G0024Each additional 30 minutes of PIN time (use with G0023).RequirementsAdd-on to G0023; one per further full 30 minutes, up to four (180 minutes).
Documentation required every cycle
- The initiating visit and the practitioner's designation of the serious condition.
- Each navigator's PIN qualification, and the practitioner's confirmation of training on the condition.
- Time log of navigator activities.
- Care plan covering: condition-specific navigation, SDOH, caregiver support, transitions of care.
- Patient consent.
Built-in patient consentwillowbridge exclusive
Every program ships with compliant, CY-2026 patient consent language — read verbatim into the in-app consent capture flow, captured with date + modality, and version-pinned to each claim, so the consent on file always matches the consent that was billed. No more chasing signatures or re-papering when the rule changes.
Common questions
Who qualifies for Principal Illness Navigation (PIN)?
The billing practitioner has seen the patient for an initiating visit (renewed every 12 months) and designated one serious, high-risk condition expected to last at least 3 months. Each navigator has a PIN qualification on file — the state's certification, or training in the seven CMS competencies — and the practitioner has confirmed they are trained on the patient's condition. Patient consent on file. Care plan addresses the serious illness, social drivers of health, and patient/caregiver education. Can be billed in the same month as CCM, PCM, APCM, BHI or CHI, even by the same practitioner; each logged minute counts toward one program only.
Which codes does willowbridge bill for PIN, and when?
Bill G0023 at 60 minutes of staff and provider time combined, then one G0024 for each further full 30 minutes — up to four add-ons at 180 minutes, beyond which a month is reviewed by hand. The PIN peer-support codes (G0140 / G0146) are not offered.
Related programs
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