Revenue Cycle Insider

Understand the difference between PIN and PIN-PS.

Coders and billers in oncology still have a lot of questions about principal illness navigation (PIN) services, even though they have been around since Jan. 1, 2024.

That’s because it’s easy to get confused by the sheer number of care management services that look similar to G0023 (Principal illness navigation services by certified or trained auxiliary personnel under the direction of a physician or other practitioner, including a patient navigator; 60 minutes per calendar month …), G0024 (… additional 30 minutes per calendar month (list separately in addition to G0023)), G0140 (Principal illness navigation - peer support by certified or trained auxiliary personnel under the direction of a physician or other practitioner, including a certified peer specialist; 60 minutes per calendar month …), and G0146 (… peer support, additional 30 minutes per calendar month (list separately in addition to G0140)). More, the descriptors for G0023 and G0140 each contain a bewildering number of component services that must be performed before PIN services can be billed.

So, we compiled the answers to your frequently asked questions about PIN to help you determine if and how you should provide the services to your chronically ill cancer patients.

What Are PIN Services, and How Do They Differ From PCM, CCM, and TCM?

Understanding the difference between principal care management (PCM), chronic care management (CCM), and transitional care management (TCM) services is hard enough, but when you add PIN services into the picture, everything gets very muddied. However, you can keep all the services straight by understanding the following definitions:

• PCM (99424, +99425, 99426, +99427) describes services to patients with a single chronic condition that is expected to last at least three months. The services are provided under the direction of a physician or a qualified healthcare professional.
• CCM (99491, +99437, 99490, +99439), describes services to patients with two or more chronic conditions that are expected last at least 12 months or until the death of the patient. These services are also provided under the direction of a physician or a qualified healthcare professional.
• TCM (99495, 99496) describes services to patients who are transitioning from inpatient care back into a community setting. These services are also provided under the direction of a physician or a qualified healthcare professional.

PIN (G0023, G0024, G0140, G0146), on the other hand, describes services to patients with one or multiple serious high-risk conditions that are expected to last at least three months and pose a significant risk of hospitalization, functional decline, acute exacerbation or decompensation, or death. They differ from the other care management services in two important ways, however:

• Care management services “are primarily focused on clinical aspects of care… [while] PIN services are focused on patient support and social aspects of care,” according to the American Academy of Family Physicians (AAFP).
• PIN services are provided by a patient navigator or certified peer specialist under the direction of a physician or other practitioner.

(For more information on the different types of care management services and their codes, consult “Take Time to Code Care Management Services Correctly,” originally published in Revenue Cycle Insider in February 2025.)

What Constitutes PIN Services?

The code descriptors for G0023 and G0140 are lengthy and need to be read closely. However, the AAFP has created a useful summary of the various services grouped under the PIN umbrella. They include:

• Health system navigation assistance
• Person-centered planning
• Identifying or referring patient and caregiver or family, if applicable, to supportive services
• Patient self-advocacy promotion
• Facilitating access to community-based resources

What’s the Difference Between G0023 and G0140?

PIN Peer Support (PIN-PS) services “are slightly distinct from PIN services in that these services are often facilitated by peer support specialists who directly assist patients in helping to navigate various health system and social sector interactions, whereas navigators may serve as a more direct point of contact on behalf of the patient,” according to the 2025 Medicare Physician Fee Schedule (MPFS) final rule. 

Who Can Provide PIN Services?

To bill for G0023 and G0024, Medicare states that “auxiliary personnel providing PIN services under the general supervision of the billing physician or other practitioner … must meet applicable State requirements, including certification or licensure.”

The Centers for Medicare & Medicaid Services (CMS) Health-Related Social Needs FAQ document goes on to note that “in States with no applicable requirements, auxiliary personnel providing PIN services must be trained or certified in the competencies of:

1. “Patient and family communication
2. “Interpersonal and relationship-building
3. “Patient and family capacity building
4. “Service coordination and systems navigation
5. “Patient advocacy, facilitation, individual and community assessment
6. “Professionalism and ethical conduct
7. “Development of an appropriate knowledge base, including specific certification or training on the serious, high-risk condition, illness, or disease being addressed.”

Such competencies can be satisfied by being credentialed by programs such as the American Cancer Society Leadership in Oncology Navigation (ACS LIONTM) and the Academy of Oncology Nurse & Patient Navigators (AONN+).

Auxiliary personnel performing PIN-PS services (G0140 and G0146), on the other hand, must either meet applicable state requirements, including certification or licensure, or “in States with no applicable requirements, auxiliary personnel providing PIN-PS services must be trained consistent with the National Model Standards for Peer Support Certification published by the Substance Abuse Mental Health Services Administration (SAMHSA),” according to the Health-Related Social Needs FAQ document.

Can PIN Services Be Billed With Care Management?

Yes. PIN services can be reported along with PCM, CCM, and TCM in the same calendar month. However, requirements for both services [must be] met…” and “time and effort for both services must be unique,” according to the AAFP. In other words, time and work for each service should only be counted once. The AAFP also goes on to say that “PIN and PIN-PS services should not be reported concurrently for the same condition,” which means you should not code G0023 and G0140 together in the same calendar month.

Bruce Pegg, BA, MA, CPC, CFPC, Managing Editor, AAPC