Talk with us CARE PROGRAM GUIDE · PIN
Principal Illness Navigation
A navigator helps a patient with a serious illness understand the care plan, reach needed services, and solve practical barriers.
FIRST, THE SHORT ANSWER
What would PIN add to care?
PIN is navigation connected to a serious, high-risk condition and its disease-specific plan. It helps patients understand care, coordinate services, and address practical barriers through trained personnel under a treating practitioner.
PIN does not require a home monitoring device. It does require accessible care-plan information, documented navigation activities, and reliable communication with the practitioner.
PATIENT & PRACTICE FIT
Could this help people you treat?
Potential fit
One serious condition expected to last at least three months with substantial risk, a qualifying initiating visit by the eventual billing practitioner, a disease-specific plan, consent, and trained navigation personnel.
Check before enrolling
No qualifying serious condition or initiating visit; a generic directory/referral service unrelated to treatment; no appropriate personnel training or supervision; or duplicate navigation for the same condition.
PATIENT EXPERIENCE
A navigator helps the patient and caregiver understand the disease-specific plan, locate needed services, solve access problems, and return unanswered clinical questions to the treating team.
SEE IT IN PRACTICE
Care between visits, step by step.
Meet Denise: cancer treatment involves several appointments, transport difficulties, and questions her caregiver cannot easily resolve.
The goal: Help Denise complete the treating team’s plan and bring clinical questions back to that team.
Choose a stage to see what the patient, treating practice, and PrimeVital’s agreed team each do.
Identify the need
Initiating visit- Patient / caregiver
- Discusses the illness, barriers, consent, and costs.
- Treating practice
- Performs the qualifying visit and establishes the condition-specific plan.
- PrimeVital’s agreed role
- Helps map navigation needs and the agreed support arrangement.
- What gets recorded
- Qualifying serious condition, visit, plan, and consent.
Illustrative scenario, not a patient record or clinical protocol. Clinical targets, review frequency, staff qualifications, escalation, and service hours are agreed with the treating practice. Clinical decisions stay with qualified personnel.
SAMPLE CARE PLAN
A plan the patient and the team can understand.
Help Denise complete the treating team’s plan and bring clinical questions back to that team.
- Patient task
- Identify barriers, preferences, and questions with her navigator.
- Clinical owner
- The treating practitioner owns the serious-illness plan and clinical decisions.
- Team follow-up
- Help coordinate appointments, transport resources, caregiver communication, and access to instructions.
- Review
- Review unresolved barriers and completed handoffs each month.
After launch: the continuing period
Update priorities as treatment changes. Navigation supports access and understanding; it does not replace the practitioner’s disease-management decisions.
YOUR INVOLVEMENT
Clinical ownership stays with the treating practice.
The agreement names the people, work, coverage hours, records access, and handoffs. Technology and operational support do not transfer clinical or billing authority.
What your clinician does
The eligible practitioner who performs the initiating visit and owns the treatment plan bills the subsequent PIN service, subject to the code and payer rules.
What supporting staff can do
Trained auxiliary personnel, including external or contracted navigators when requirements are met, may furnish the service under general supervision. Auxiliary personnel do not independently bill PIN.
What we can organize with you
PrimeVital can help define navigator tasks, training checks, patient handoffs, and documentation under the practice’s clinical authority when the specific engagement supports PIN.
PrimeVital’s full care arrangement includes applicable devices and a care-management team. The program determines which resources and professional qualifications are needed. Interactly can support front-desk tasks within the agreed scope; 24/7 PrimeVital clinical coverage is not assumed.
REQUIREMENTS BEFORE LAUNCH
Make the pathway ready before enrolling patients.
- Confirm the serious illness, initiating visit, practitioner, and disease-specific plan.
- Obtain and document consent at commencement and annually; renew if the billing practitioner changes. Verify trained personnel and general supervision.
- Record patient-specific navigation and qualifying monthly time.
- Check overlapping navigation or model payments before billing.
Detailed operating workflow and technology
- 1
Initiate
Document the serious condition, qualifying visit, disease-specific plan, and consent.
- 2
Assign
Identify trained navigation personnel and an accountable treating practitioner.
- 3
Navigate
Help the patient access care and report clinical issues back to the practitioner.
- 4
Reconcile
Record qualifying monthly activity, time, supervision, and no duplicate service.
Technology and records: PIN does not require a home monitoring device. It does require accessible care-plan information, documented navigation activities, and reliable communication with the practitioner.
GETTING PAID
Who receives payment, and what earns it?
Care need, completed services, evidence, and the actual payer determine the claim. A covered service or an enrollment is not the same as collected revenue.
The eligible treating practitioner reports qualifying navigation under the appropriate PIN pathway. Navigators do not independently bill Medicare for PIN. PrimeVital’s role and payment come through its agreement with the treating organization.
Original Medicare Part B recognizes qualifying PIN after an appropriate initiating visit. CMS requires condition-specific navigation, trained personnel, consent, and practitioner oversight.
Check Medicare Advantage, Medicaid, commercial, and value-based contracts for coverage or potentially overlapping navigation payments.
CMS requires consent and an explanation that Medicare cost sharing may apply; verify supplemental or plan coverage and QMB protections where relevant.
Payment boundaryPIN is not interchangeable with CHI: PIN concerns one serious, high-risk condition; CHI addresses social needs that significantly limit diagnosis or treatment. Do not duplicate PIN services for the same condition and practitioner.
2026 code reference and an illustrative service check
Navigation must relate to the qualifying serious-illness plan, with trained personnel, initiating visit, consent, supervision, and qualifying time. A resource directory alone is not the complete service.
These are code-family summaries, not complete descriptors or payment estimates. Check the current code set, payer, clinician, setting, date, unit edits, and required add-on base code.
| Code / pathway | What it describes | Before billing |
|---|---|---|
| G0023 / G0024 | Principal illness navigation | First 60 minutes and each additional 30 minutes per month for an eligible serious condition. |
| G0140 / G0146 | PIN peer-support pathway | First 60 minutes and each additional 30 minutes per month for behavioral-health peer-support navigation, with specific personnel requirements. |
Questions before a claim
Can a community organization supply navigators?
CMS permits external contracted auxiliary personnel in qualifying arrangements, with practitioner supervision and personnel requirements.
Can a navigator bill Medicare independently?
No. The eligible treating practitioner retains the billing role for the PIN service.
FINANCIAL PICTURE
See how participation, collections, and costs change the result.
Start with one supported pathway. Do not multiply every patient by every possible code. Use verified payer terms and the written PrimeVital scope before making a business decision.
Illustrative PIN model
These starting figures are hypothetical. They are not Medicare rates, a PrimeVital quote, or a payment forecast. PrimeVital pilot terms are not modelled automatically. Replace them with your verified contract, service mix, and cost assumptions.
Estimate net after your agreed service fee and other costs
Enter the total fees from your written agreement. No fee is prefilled. Pilot service fees are paid from collections; treatment of denied or insufficient collections must be agreed before launch.
Leave at zero if already included in the service fee. Avoid counting it twice.
Shown separately from recurring operating costs.
35 of 50 patients meet the assumed service requirements.
Illustrative collections before service and practice costs: $3,500. This uses the hypothetical per-patient amount and collection rate above; it is not a code-specific Medicare estimate.
To estimate the amount remaining for the practice, open the cost section and enter the total service fee from a written proposal. We do not invent a PrimeVital price or show a misleading net amount before that is known.
Contribution is before other overhead and taxes. Actual billing uses service-level evidence and rules; this simplified model does not select codes, approve eligibility, or guarantee outcomes. Patient cost sharing and QMB protections must be checked separately.
BENEFITS TO MEASURE
Define success before the first patient starts.
Agree on a baseline and review period. These are measures to track, not promised results or guaranteed payment.
Access
Appointments and resources reached.
Barriers
Unresolved transport, caregiver, or understanding needs.
Handoffs
Clinical questions returned to the treating team and closed.
PRIMARY SOURCES
Check the rule before a real claim.
Reviewed October 7, 2026 against current CMS guidance. These guides describe 2026 pathways; proposals for later years are not effective requirements. Coverage, contracts, scope, and patient facts can change the answer.
APPLY THIS TO YOUR PRACTICE
Start with a patient group and a clear question.
Tell us your practice type, payer mix, and workflow. We can map clinical fit, your involvement, available support, launch requirements, and financial assumptions to verify.
DESIGN A PRACTICAL STARTING POINT
Tell us where the workflow is breaking. We’ll show you where to begin.
Send us a message
Continue on your phoneScan to open a pre-addressed email draft.Email contact@theprimevital.com