CMS created 2 new service codes describing CHI services that auxiliary personnel, including community health workers (CHWs), may perform incidental to the professional services of a physician or other billing practitioner, under general supervision. The billing practitioner initiates CHI services during an initiating visit where the practitioner identifies unmet SDOH needs that significantly limit their ability to diagnose or treat the patient.
The new G codes for CHI:
G0019 – Community health integration services performed by certified or trained auxiliary personnel, including a community health worker, under the direction of a physician or other practitioner; 60 minutes per calendar month, in the following activities to address social determinants of health (SDOH) need(s) that significantly limit the ability to diagnose or treat problem(s) addressed in an initiating visit:
Person-centered assessment, performed to better understand the individualized context of the intersection between the SDOH need(s) and the problem(s) addressed in the initiating visit
■ Conducting a person-centered assessment to understand the patient’s life story, strengths, needs, goals, preferences and desired outcomes, including understanding cultural and linguistic factors and including unmet SDOH needs (that aren’t separately billed)
■ Facilitating patient-driven goal-setting and establishing an action plan
■ Providing tailored support to the patient as needed to accomplish the practitioner’s treatment plan
Practitioner, home-, and community-based care coordination
■ Coordinating receipt of needed services from health care practitioners, providers, and
facilities; and from home- and community-based service providers, social service providers,
and caregiver (if applicable)
■ Communication with practitioners, home- and community-based service providers, hospitals,
and skilled nursing facilities (or other health care facilities) regarding the patient’s psychosocial
strengths and needs, functional deficits, goals, preferences, and desired outcomes, including
cultural and linguistic factors
■ Coordination of care transitions between and among health care practitioners and settings,
including transitions involving referral to other clinicians; follow-up after an emergency
department visit; or follow-up after discharges from hospitals, skilled nursing facilities or other
health care facilities
■ Facilitating access to community-based social services (e.g., housing, utilities, transportation,
food assistance) to address the SDOH need(s)
○ Health education – helping the patient contextualize health education provided by the patient’s treatment team with the patient’s individual needs, goals, and preferences, in the context of SDOH need(s), and educating the patient on how to best participate in medical decision-making
○ Building patient self-advocacy skills, so that the patient can interact with members of the health care team and related community-based services addressing the SDOH need(s), in ways that are more likely to promote personalized and effective diagnosis or treatment
○ Health care access/health system navigation
■ Helping the patient access health care, including identifying appropriate practitioners or providers for clinical care and helping secure appointments with them
Facilitating behavioral change as necessary for meeting diagnosis and treatment goals, including promoting patient motivation to participate in care and reach person-centered diagnosis or treatment goals
Facilitating and providing social and emotional support to help the patient cope with the problem(s) addressed in the initiating visit, the SDOH need(s), and adjust daily routines to better meet diagnosis and treatment goals
Leveraging lived experience when applicable to provide support, mentorship, or inspiration to meet
treatment goals
G0022 – Community health integration services, each additional 30 minutes per calendar month (List
separately in addition to G0019)
Important points about CHI codes:
- Time based codes
- Consent is required only once (rather than annually)
- In-person and virtually
- Only one provider can bill for CHI services
- Other CCM services can be billed separately as long as there is no double dipping on time
- Not covered when a beneficiary is under a home health plan of care under Medicare part B
Note: Certain types of E/M visits, such as inpatient and observation visits, emergency department (ED) visits, and skilled nursing facility (SNF) visits, wouldn’t serve as CHI initiating visits because the practitioners providing the E/M visit wouldn’t typically be the one providing continuing care to the patient, including providing necessary CHI services in the subsequent months.