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CMS Proposal: Timing and Billing Increments for Principal Illness Navigation Svc

  • Clara Lambert
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CMS Proposal: Timing and Billing Increments for Principal Illness Navigation Svc was created by Clara Lambert

Posted 8 months 3 weeks ago #101
In order for PIN (Principal Illness Navigation) Services to be reimbursable, CMS would require an initiating Evaluation and Management (E/M) visit by a billing practitioner to identify the medical necessity of PIN services. This evaluation visit would have to occur prior to any navigation services being rendered.

New billing code GXXX3 would allow one 60-minute PIN visit per calendar month, and new billing code GXXX4 would allow subsequent 30-minute PIN increments per calendar month.

CMS is seeking feedback as to whether it should consider any professional services other than an E/M visit performed by the billing practitioner as the prerequisite initiating visit for PIN services.

CMS is also seeking comments on the typical amount of time practitioners spend furnishing navigation services (minutes per month per individual patient), as well as the typical duration of navigation services (number of months per individual patient) following an initial visit.

When submitting comments to CMS on these two topics, please reference:88 FR 52262 (proposed August 7, 2023) – Medicare and Medicaid Programs; CY 2024 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies, section II.E.(27)(e)(ii)
by Clara Lambert

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