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Supported Line of Business: Medicare Advantage

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Overview

Principal Illness Navigation (PIN) services were established by CMS in the CY 2024 Physician Fee Schedule (PFS) Final Rule and became billable starting January 1, 2024. They are designed to help Medicare patients with serious, high-risk conditions navigate their treatment and address unmet social needs. PIN services are incident-to services performed by auxiliary personnel (patient navigators, community health workers, peer support specialists) under the general supervision of a billing practitioner.

There are no National or Local Coverage Determinations (NCDs/LCDs) specific to PIN — the policies are governed entirely through the PFS final rules.

There are two types of Principal Illness Navigation services, and they’re determined by the type of serious, high-risk condition and therefore qualifications of the auxiliary personnel:

1. Principal Illness Navigation (PIN): requires ≥ 1 serious, high risk medical condition. Auxiliary staff must meet CMS training and/or state licensure requirements to provide illness navigation which Bridge as outlined here in our Staff Oversight Policy for Principal Illness Navigation (PIN) & Community Health Integration (CHI)
2. Principal Illness Navigation - Peer Support (PIN-PS)*: requires ≥ 1 serious, high risk behavioral health condition. Auxiliary staff must meet training and/or state licensure requirements specific to Peer Support training which Bridge as outlined here in our Staff Oversight Policy for Principal Illness Navigation (PIN) & Community Health Integration (CHI)

Consent requirements

Providers must obtain and document patient consent before initiating Principal Illness Navigation (PIN) services. We recommend combining informed consent for Telehealth + Principal Illness Navigation (PIN) or Principal Illness Navigation - Peer Support (PIN-PS) services into one policy for operational simplicity.

• Consent to treat and consent to PIN or PIN - PS services policy will be provided
• Must be linked in the patient signup flow and collected with a check box before the visit
• Record collection of the consent against the consent API

Auxiliary Personnel requirements

Partners are expected to adhere to Bridge’s Staff Oversight Policy for Principal Illness Navigation (PIN) & Community Health Integration (CHI)

The auxiliary personnel supervised under the billing Provider must meet applicable state requirements, including licensure (see Staff Oversight Policy). In states with no applicable requirements, auxiliary personnel providing PIN services must be trained or certified in the competencies of:

• Patient and family communication
• Interpersonal and relationship-building
• Patient and family capacity building
• Service coordination and systems navigation
• Patient advocacy, facilitation, individual and community assessment