How To Use HCPCS Code G0019

HCPCS code G0019 describes community health integration services performed by certified or trained auxiliary personnel, including a community health worker, under the direction of a physician or other practitioner. These services are aimed at addressing social determinants of health (sdoh) needs that significantly limit the ability to diagnose or treat the problem(s) addressed in an initiating visit. The services provided under this code are person-centered and focus on assessing the individual’s context, establishing goals, coordinating care, providing health education, and facilitating access to community-based social services.

1. What is HCPCS G0019?

HCPCS code G0019 is used to identify community health integration services performed by certified or trained auxiliary personnel, such as community health workers, under the direction of a physician or other practitioner. These services are provided for a duration of 60 minutes per calendar month and are aimed at addressing social determinants of health (sdoh) needs that significantly limit the ability to diagnose or treat the problem(s) addressed in an initiating visit.

2. Official Description

The official description of HCPCS code G0019 is “Community health integration services performed by certified or trained auxiliary personnel, including a community health worker, under the direction of a physician or other practitioner; 60 minutes per calendar month, in the following activities to address social determinants of health (sdoh) need(s) that are significantly limiting the ability to diagnose or treat problem(s) addressed in an initiating visit: person-centered assessment, performed to better understand the individualized context of the intersection between the sdoh need(s) and the problem(s) addressed in the initiating visit.”

The short description for HCPCS code G0019 is “Comm hlth intg svs sdoh 60mn.”

3. Procedure

1. Person-Centered Assessment: The certified or trained auxiliary personnel will conduct a person-centered assessment to better understand the individual’s life story, strengths, needs, goals, preferences, and desired outcomes. This assessment includes understanding cultural and linguistic factors and identifying any unmet social determinants of health (sdoh) needs that are not separately billed.
2. Facilitating Goal-Setting and Action Plan: The personnel will facilitate patient-driven goal-setting and help establish an action plan based on the assessment. This involves tailoring support to the patient as needed to accomplish the practitioner’s treatment plan.
3. Coordination of Care: The personnel will coordinate the receipt of needed services from healthcare practitioners, providers, and facilities, as well as home- and community-based service providers, social service providers, and caregivers if applicable. They will also communicate with various healthcare stakeholders regarding the patient’s psychosocial strengths and needs, functional deficits, goals, preferences, and desired outcomes.
4. Transitions of Care: The personnel will coordinate care transitions between and among healthcare practitioners and settings. This includes transitions involving referrals to other clinicians, follow-up after emergency department visits, or follow-up after discharges from hospitals, skilled nursing facilities, or other healthcare facilities.
5. Access to Community-Based Social Services: The personnel will facilitate access to community-based social services such as housing, utilities, transportation, and food assistance to address the social determinants of health (sdoh) needs.
6. Health Education: The personnel will help contextualize health education provided by the patient’s treatment team with the patient’s individual needs, goals, and preferences in the context of the social determinants of health (sdoh) needs. They will also educate the patient on how to best participate in medical decision-making and build self-advocacy skills.
7. Healthcare Access and Navigation: The personnel will assist the patient in accessing healthcare by identifying appropriate practitioners or providers for clinical care and helping secure appointments with them. They will also facilitate behavioral change as necessary for meeting diagnosis and treatment goals and provide social and emotional support to help the patient cope with the addressed problem(s) and adjust daily routines.
8. Leveraging Lived Experience: When applicable, the personnel may provide support, mentorship, or inspiration based on their own lived experience to help the patient meet their treatment goals.

4. When to use HCPCS code G0019

HCPCS code G0019 should be used when the certified or trained auxiliary personnel, including community health workers, perform community health integration services to address social determinants of health (sdoh) needs that significantly limit the ability to diagnose or treat the problem(s) addressed in an initiating visit. These services are person-centered and involve activities such as person-centered assessment, goal-setting, care coordination, health education, healthcare access, and navigation.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G0019, healthcare providers need to document the services provided and ensure that the documentation supports the medical necessity of the services. The documentation should include details of the person-centered assessment, goal-setting, care coordination activities, health education provided, and any facilitation of access to community-based social services. It is important to accurately reflect the time spent on each activity and the patient’s specific social determinants of health (sdoh) needs addressed.

6. Historical Information and Code Maintenance

HCPCS code G0019 was added to the Healthcare Common Procedure Coding System on January 01, 2024. It has an effective date of January 01, 2024. As of now, there have been no maintenance actions taken for this code.

7. Medicare and Insurance Coverage

HCPCS code G0019 is payable by Medicare. The pricing indicator code for this code is 13, which means the price is established by carriers based on carrier judgment. The multiple pricing indicator code is A, indicating that it is not applicable as HCPCS is priced under one methodology. Other insurance providers may also cover this code, but coverage may vary. It is important to check with individual insurance plans for their specific coverage policies.

8. Examples

Here are some examples of when HCPCS code G0019 should be billed:

1. A certified community health worker spends 60 minutes conducting a person-centered assessment, facilitating goal-setting, coordinating care, and providing health education to a patient with unmet social determinants of health (sdoh) needs.
2. A trained auxiliary personnel assists a patient in accessing healthcare services, coordinating care transitions, and facilitating access to community-based social services for addressing social determinants of health (sdoh) needs.
3. A community health worker provides tailored support to a patient to accomplish the practitioner’s treatment plan, including coordinating receipt of needed services from healthcare practitioners and providers.
4. A certified auxiliary personnel conducts a person-centered assessment, facilitates goal-setting, and educates the patient on how to best participate in medical decision-making, considering the patient’s social determinants of health (sdoh) needs.
5. A community health worker leverages their lived experience to provide support and mentorship to a patient, helping them cope with the addressed problem(s) and adjust daily routines to better meet diagnosis and treatment goals.