How To Use HCPCS Code G0140

HCPCS code G0140 describes the principal illness navigation service provided by certified or trained auxiliary personnel under the direction of a physician or other practitioner. This service involves peer support and is intended to assist patients with serious, high-risk conditions in navigating their healthcare journey. The service includes various activities such as person-centered interviews, goal setting, support in accessing community-based social services, health education, and providing social and emotional support. In this article, we will explore the details of HCPCS code G0140 and how it should be used in medical coding.

1. What is HCPCS G0140?

HCPCS code G0140 is a specific code used to identify the principal illness navigation service provided by certified or trained auxiliary personnel. This service is performed under the direction of a physician or other practitioner and involves peer support for patients with serious, high-risk conditions. The service is provided for a duration of 60 minutes per calendar month and includes various activities aimed at assisting patients in their healthcare journey.

2. Official Description

The official description of HCPCS code G0140 is as follows: “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, in the following activities: person-centered interview, performed to better understand the individual context of the serious, high-risk condition. ++ conducting a person-centered interview to understand the patient’s life story, strengths, needs, goals, preferences, and desired outcomes, including understanding cultural and linguistic factors, and including unmet sdoh needs (that are not billed separately). ++ facilitating patient-driven goal setting and establishing an action plan. ++ providing tailored support as needed to accomplish the person-centered goals in the practitioner’s treatment plan. identifying or referring patient (and caregiver or family, if applicable) to appropriate supportive services. practitioner, home, and community-based care communication. ++ assist the patient in communicating with their practitioners, home-, and community-based service providers, hospitals, and skilled nursing facilities (or other health care facilities) regarding the patient’s psychosocial strengths and needs, goals, preferences, and desired outcomes, including cultural and linguistic factors. ++ facilitating access to community-based social services (e.g., housing, utilities, transportation, food assistance) as needed to address sdoh need(s). health education. helping the patient contextualize health education provided by the patient’s treatment team with the patient’s individual needs, goals, preferences, and sdoh need(s), and educating the patient (and caregiver if applicable) on how to best participate in medical decision-making. building patient self-advocacy skills, so that the patient can interact with members of the health care team and related community-based services (as needed), in ways that are more likely to promote personalized and effective treatment of their condition. developing and proposing strategies to help meet person-centered treatment goals and supporting the patient in using chosen strategies to reach person-centered treatment goals. facilitating and providing social and emotional support to help the patient cope with the condition, sdoh need(s), and adjust daily routines to better meet person-centered diagnosis and treatment goals. leverage knowledge of the serious, high-risk condition and/or lived experience when applicable to provide support, mentorship, or inspiration to meet treatment goals.”

3. Procedure

1. The provider initiates the principal illness navigation service by conducting a person-centered interview with the patient. This interview aims to better understand the individual context of the serious, high-risk condition. It involves gathering information about the patient’s life story, strengths, needs, goals, preferences, and desired outcomes, including cultural and linguistic factors.
2. Based on the information gathered during the interview, the provider facilitates patient-driven goal setting and establishes an action plan. This involves working collaboratively with the patient to identify their goals and develop a plan to achieve them.
3. The provider provides tailored support to the patient as needed to accomplish the person-centered goals outlined in the practitioner’s treatment plan. This support may include assisting the patient in accessing appropriate supportive services, such as referrals to community resources or healthcare facilities.
4. The provider helps the patient in communicating with their practitioners, home- and community-based service providers, hospitals, and skilled nursing facilities regarding their psychosocial strengths and needs, goals, preferences, and desired outcomes. This communication aims to ensure coordinated care and address any cultural or linguistic factors that may impact the patient’s healthcare journey.
5. If necessary, the provider facilitates access to community-based social services, such as housing, utilities, transportation, or food assistance, to address social determinants of health needs.
6. The provider assists the patient in contextualizing health education provided by their treatment team with their individual needs, goals, preferences, and social determinants of health needs. They also educate the patient (and caregiver if applicable) on how to best participate in medical decision-making.
7. Building patient self-advocacy skills is an essential part of the principal illness navigation service. The provider helps the patient interact with members of the healthcare team and related community-based services in ways that promote personalized and effective treatment of their condition.
8. The provider develops and proposes strategies to help meet person-centered treatment goals and supports the patient in using the chosen strategies to reach those goals.
9. Additionally, the provider offers social and emotional support to help the patient cope with their condition, social determinants of health needs, and adjust daily routines to better meet person-centered diagnosis and treatment goals.
10. When applicable, the provider leverages their knowledge of the serious, high-risk condition and/or lived experience to provide support, mentorship, or inspiration to the patient in meeting their treatment goals.

4. When to use HCPCS code G0140

HCPCS code G0140 should be used when a certified or trained auxiliary personnel, under the direction of a physician or other practitioner, provides the principal illness navigation service described in the official description. This service is specifically intended for patients with serious, high-risk conditions who require peer support in navigating their healthcare journey. It is important to ensure that the service is performed for a duration of 60 minutes per calendar month and includes the activities outlined in the official description.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G0140, healthcare providers need to document the following:

• Documentation of the person-centered interview conducted with the patient, including details of the patient’s life story, strengths, needs, goals, preferences, and desired outcomes.
• Documentation of the patient-driven goal setting and the establishment of an action plan.
• Documentation of tailored support provided to the patient to accomplish the person-centered goals in the practitioner’s treatment plan.
• Documentation of any identified or referred supportive services for the patient and, if applicable, their caregiver or family.
• Documentation of communication with practitioners, home- and community-based service providers, hospitals, and skilled nursing facilities regarding the patient’s psychosocial strengths and needs, goals, preferences, and desired outcomes.
• Documentation of any facilitated access to community-based social services to address social determinants of health needs.
• Documentation of health education provided to the patient, including how it is tailored to their individual needs, goals, preferences, and social determinants of health needs.
• Documentation of strategies proposed to help meet person-centered treatment goals and support provided to the patient in using those strategies.
• Documentation of social and emotional support provided to the patient to help them cope with their condition and social determinants of health needs.
• Documentation of any utilization of the provider’s knowledge of the serious, high-risk condition and/or lived experience to provide support, mentorship, or inspiration to the patient.

6. Historical Information and Code Maintenance

HCPCS code G0140 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, as indicated by the action code A, which means no maintenance for this code.

7. Medicare and Insurance Coverage

Medicare coverage for HCPCS code G0140 is determined by carrier judgment (coverage code C). The pricing indicator code for this code is 13, which means the price is established by carriers. The multiple pricing indicator code is A, indicating that it is not applicable as HCPCS priced under one methodology. It is important to check with individual insurance providers to determine coverage and reimbursement for this service.

8. Examples

Here are some examples of scenarios where HCPCS code G0140 may be billed:

1. A patient with a serious, high-risk condition requires assistance in navigating their healthcare journey. A certified peer specialist conducts a person-centered interview, facilitates goal setting, provides tailored support, and assists the patient in accessing community-based social services.
2. A patient with a serious, high-risk condition needs help in communicating with their practitioners and home- and community-based service providers. An auxiliary personnel under the direction of a physician facilitates communication and ensures that the patient’s psychosocial strengths and needs are effectively conveyed.
3. A patient with a serious, high-risk condition requires health education that is tailored to their individual needs and social determinants of health needs. An auxiliary personnel provides contextualized health education and educates the patient on how to actively participate in medical decision-making.
4. A patient with a serious, high-risk condition needs social and emotional support to cope with their condition and adjust their daily routines. A certified peer specialist provides support and mentorship to help the patient meet their person-centered diagnosis and treatment goals.
5. A patient with a serious, high-risk condition can benefit from the lived experience of an auxiliary personnel who has successfully managed a similar condition. The auxiliary personnel provides support, mentorship, and inspiration to the patient, leveraging their knowledge and experience.