Community Health Integration Services
What are Community Health Integration (CHI) Services?
The Centers for Medicare & Medicaid Services (CMS) began reimbursing for Community Health Integration (CHI) Services on January 1, 2024. CHI services address a Traditional Medicare patient's unmet social needs affecting the diagnosis and treatment of their medical conditions.
CHI services include:
- Person-centered assessment and planning
- Care coordination and health system navigation
- Patient education and self-advocacy skill building
Why provide CHI services?
Unmet social needs — including transportation, housing, food, financial security, and social support — can affect a patient's ability to receive needed healthcare services and manage their condition. CHI services are intended to support patients in accessing the needed resources to help diagnose and treat their medical condition. For example, a patient without transportation may not be able to access necessary testing or treatment services. Addressing these needs can help patients receive timely care, enhance your practice's efficiency, and improve patient compliance and satisfaction. Further, CHI services can support providers participating in alternative payment models to achieve quality goals.
Who can provide CHI Services?
CHI services must be initiated by a billing practitioner during an initiating visit where the practitioner identifies unmet health-related social needs. The billing practitioner can be a physician, nurse practitioner, physician assistant, or certified nurse midwife.
Auxiliary personnel, including community health workers (CHWs), nurses, or social workers, may perform CHI services incidental to the billing practitioner under general supervision. The same practitioner bills for the subsequent CHI services provided by the auxiliary personnel.
Auxiliary personnel who provide CHI services may be employed by the billing practitioner or may be external to, and under contract with, the practitioner. For example, a physician practice may contract with a community-based organization employing CHWs or other auxiliary personnel if they meet all “incident to” requirements and conditions for payment of CHI services.
If your practice chooses to use auxiliary personnel, note that they must meet all applicable state requirements, including licensure. If your state does not have any applicable requirements, these personnel must be certified and trained in the following competencies:
- Patient and family communication
- Interpersonal and relationship-building skills
- Patient and family capacity building
- Service coordination and systems navigation
- Patient advocacy, facilitation, individual and community assessment
- Professionalism and ethical conduct
- Development of an appropriate knowledge base, including of local community-based resources
What is required for a CHI initiating visit?
CHI services require an initiating visit with a billing practitioner prior to the start of CHI services. An initiating visit can be:
- An Evaluation and Management (E/M) visit, with the exception of level 1 visits performed by clinical staff, or
- An Annual Wellness Visit (AWV)
During the initiating visit, the practitioner should identify and document the unmet social needs affecting the ability to diagnose and/or treat the patient. During this visit, the practitioner will also establish the CHI services.
The practitioner or the auxiliary personnel providing CHI services must get patient consent in advance of providing CHI services to ensure patients are aware of cost sharing requirements. Consent can be written or verbal and documented in the patient's medical record.
What are the billing codes for CHI Services?
There are two CPT codes for CHI services:
- G0019: CHI services performed by certified or trained auxiliary personnel under general supervision; 60 minutes per calendar month.
- G0022: CHI services, each additional 30 minutes per calendar month (Listed separately in addition to G0019)
While CHI services should include some in-person interaction, services can also be provided virtually, including videoconference and audio-only.
Only one practitioner can bill for CHI services per month for a patient. Other care management services can be furnished in the same month if the services are medically reasonable and necessary, meet the requirements, and efforts are not counted more than once.
How do I document CHI services in my electronic health record (EHR)?
During the initiating visit, the billing practitioner must document the patient's unmet social needs that will be addressed with CHI services in the medical record. ICD-10 Z-codes can be used to document the unmet social needs. Further, the billing practitioner must document patient consent, including that the patient acknowledges cost sharing and that services may only be provided by one practitioner per month.
When providing CHI services, the amount of time spent with the patient and the types of activities conducted should be documented in the patient's medical record.
Are there any special considerations for Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) billing for CHI services?
RHCs and FQHCs can bill for CHI services using the HCPCS Code G0511, either alone or with other payable services. CMS allows RHCs and FQHCs to bill concurrently for care management services. This means that RHCs and FQHCs can provide CHI, Transitional Care Management (TCM), and other care management services for the same patient in the same service period.
As of January 1, 2024, RHCs and FQHCs can bill G0511 multiple times in a calendar month so long as they are: “medically reasonable and necessary, meet all requirements, and not be duplicative of services paid to RHCs and FQHCs under the general care management code for an episode of care in a given calendar month.” This change reflects previous guidance that stated FQHCs and RHCs could only bill G0511 once per month.
Resources
- Care Management, Centers for Medicare & Medicaid Services
- Health Equity Services in the 2024 Physician Fee Schedule Final Rule, Centers for Medicare & Medicaid Services
- Health-Related Social Needs FAQ, Centers for Medicare & Medicaid Services
- CMS Billing Lingo, Defined!, National Association of Community Health Centers
- Payment Reimbursement Tips: Community Health Integration (CHI), National Association of Community Health Centers
- Summary of Medicare Care Management Services Billed Using G0511, National Association of Community Health Centers
- Care Management Services and Patient Navigation Services: A Comparison, American Society of Clinical Oncology
- Understanding the Medicare Physician Fee Schedule Billing Codes for: Community Health Integration (CHI), Principal Illness Navigation (PIN), Principal Illness Navigation – Peer Support (PIN-PS) Services, Partnership to Align Social Care
- Improving the Collection of Social Determinants of Health (SDOH) Data with ICD-10-CM Z Codes, Centers for Medicare & Medicaid Services Office of Minority Health
- Healthcare Guide to Contracting with CBOs, Partnership to Align Social Care
Last Updated: 11/26/2024
Last Reviewed: 11/26/2024