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

• Patient has a serious-illness designation documented in the chart.
• The performing navigator has Medicare-recognized PIN training/certification on file at the practice.
• Patient consent on file.
• Care plan addresses the serious illness, social drivers of health, and patient/caregiver education.
• Cannot be billed concurrently with CCM by the same practitioner for the same patient/month.

Codes & when to bill them

Each billable code, with the requirements that must be on file to bill it.

• G0023First 60 minutes of PIN clinical-staff time per calendar month.
  RequirementsSerious-illness designation; navigator credentials; consent; 60+ min.
• G0024Each additional 30 minutes of PIN time. Max 2 add-ons per month.
  RequirementsAdd-on to G0023.

Documentation required every cycle

1. Serious-illness designation in the chart.
2. Navigator credentials on file (PIN training certificate).
3. Time log of navigator activities.
4. Care plan covering: condition-specific navigation, SDOH, caregiver support, transitions of care.
5. 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.