In the 2024 Medicare Physician Fee Schedule (MPFS) final rule, the Centers for Medicare & Medicaid Services (CMS) finalized coding and reimbursement for Principal Illness Navigation (PIN) services, in support the White House’s Cancer Moonshot Initiative. As of January 1, 2024, oncology practitioners can bill and receive Medicare payment for connecting patients to navigation services performed by certified or trained auxiliary personnel under the direction of a billing practitioner.
CMS has adopted two billing codes for PIN services: G0023 for the initial 60 minutes per patient per month, and G0024 to capture each additional 30 minutes per patient per month. The American Society of Clinical Oncology (ASCO) has received many inquiries about coding and billing for these new services, especially regarding the training and/or certification requirements for navigators.
According to CMS, auxiliary personnel must meet any applicable requirements to provide incident to services, including licensure or other requirements, that are required by the state in which the services are being furnished. In states that do not have applicable licensure, certification, or other laws or regulations governing the certification or training of auxiliary personnel, staff performing PIN services must be trained in the competencies of and authorized to perform the following service elements:
- Patient and family communication
- Interpersonal and relationship-building
- Professionalism and ethical conduct
- Patient and family capacity-building
- Service coordination and system navigation
- Patient advocacy, facilitation
- Individual and community assessment
- Development of an appropriate knowledge base
CMS does not highlight specific training or certification programs that must be used, nor does it specify the documentation requirements practices must maintain to verify completion of a certification or training program.
The following resources have been shared with ASCO for use by oncologists and staff. ASCO does not endorse a specific training program, and this is not an exhaustive list. The Society will update this list as additional resources become available:
- American Cancer Society’s Leadership in Navigation Training
- George Washington University’s Oncology Patient Navigator’s Training: The Fundamentals
For additional information on the new PIN services, including reporting and documentation requirements, reimbursement details, activity details, and comparison to care management codes, please see ASCO’s Care Management Services and Proposed Social Determinants of Health Codes: A Comparison.
For all billing and coding questions and to report any obstacles or problems using the new PIN codes, please contact ASCO’s billing and coding team at practice@asco.org.
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