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HCPCS G0019: Community Health Integration for Social Determinants of Health

HCPCS Level II code G0019 represents a monthly, 60-minute package of community health integration services delivered by trained auxiliary personnel such as community health workers under clinician supervision to address social determinants of health that impede diagnosis or treatment. The code operationalizes non-clinical, person-centered activities — including comprehensive assessments, individualized goal-setting and action planning, coordination across medical and social service providers, facilitation of community resource access, health education in context, and support for behavior change and self-advocacy.

This code matters nationally as payers increasingly recognize the role of SDOH interventions in improving outcomes and reducing avoidable utilization. Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the service scope and typical sites of care, payer coverage landscape, and the policy and clinical context necessary to understand where G0019 fits in value-based and population health models. The publication also highlights common billing considerations and related service types; where input data is not provided, the text notes "Data not available in the input."

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Billing Code Overview

HCPCS Level II code G0019 describes community health integration services delivered by certified or trained auxiliary personnel, including community health workers, under the direction of a physician or other practitioner. The code covers a bundled set of activities totaling 60 minutes per calendar month focused on addressing social determinants of health (SDOH) that significantly limit the ability to diagnose or treat problems addressed in an initiating visit.

Service type: Community health integration / care coordination and SDOH support

Typical site of service: Community-based settings, patient home, outpatient clinics, and care-transition environments. Services include person-centered assessment, patient-driven goal-setting and action planning, coordination with healthcare and social service providers, facilitation of access to community resources (housing, transportation, food assistance), health system navigation, health education tailored to social context, behavioral change support, social and emotional support, and leveraging lived experience for mentorship and engagement.

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HCPCS G0019: Community Health Integration for Social Determinants of Health

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Billing Code Overview

Service type: Community health integration / care coordination and SDOH support

Clinical & Coding Specifications

Clinical Context

A 56-year-old woman with poorly controlled type 2 diabetes presents for an initiating primary care visit to address hyperglycemia and recurrent missed appointments. During the visit the clinician identifies unstable housing, limited access to transportation, food insecurity, and low health literacy that are significantly limiting diabetes evaluation and treatment. The clinician or care team refers the patient to a certified community health worker (CHW) to provide community health integration services under clinician direction. Over the next calendar month the CHW performs a person-centered assessment exploring the patient’s life story, strengths, goals, cultural and linguistic preferences, and unmet social determinants of health (SDOH) needs; facilitates patient-driven goal setting and an action plan tied to the treatment plan; coordinates with the primary care clinician, diabetes educator, and local food assistance program; assists in scheduling follow-up diabetes visits and securing transportation to appointments; provides tailored health education contextualized to the patient’s goals; and documents one hour (60 minutes) of aggregated CHW activity for the month to support clinical care and improved ability to diagnose and treat the diabetes-related problems identified in the initiating visit. Typical workflow includes initial clinician referral, CHW intake and assessment, care coordination communications with clinicians and community agencies, and follow-up reporting to the supervising practitioner.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier — standard billing	Use when no special circumstances apply to the service.
`22`	Increased procedural services	Use if documented work or intensity substantially exceeds typical service time or complexity beyond usual G0019 activity.
`23`	Unusual anesthesia — not applicable to G0019	Rarely used; generally not applicable for non-procedural CHW services.
`29`	Substantial, separately identifiable evaluation and management service by same physician on same day	Use when the supervising practitioner provides a distinct E/M unrelated to G0019 on the same day.
`52`	Reduced services	Use if the community health integration service was started but not completed as documented.
`53`	Discontinued procedure	Use if service was discontinued due to patient or clinical circumstances before meaningful time spent.
`80`	Assistant surgeon — not applicable	Not applicable for CHW-delivered non-surgical service.
`82`	Assistant surgeon (when qualified resident unavailable) — not applicable	Not applicable to this non-procedural service.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist as primary surgeon — not applicable	Generally not used; CHW is auxiliary personnel under direction of practitioner.
`CQ`	Service provided by a registered nurse (clinical nurse specialist, nurse practitioner) — facility claims	Use when a qualifying advanced practice provider documents and bills components in facility-based billing contexts as applicable.
`QK`	Medical direction of two, three, or four concurrent anesthesia procedures — not applicable	Not applicable to G0019.
`QX`	CRNA service with medical direction — not applicable	Not applicable to G0019.
`QY`	Medical direction of one CRNA — not applicable	Not applicable to G0019.
`SH`	Physician or practitioner services rendered in a critical access hospital as telehealth originating site facility — use per payer policy	Use when service is documented and billed from an eligible originating site per payer rules.

Taxonomy Code	Specialty	Notes
373L00000X	Community Health Worker	Direct provider of `G0019` services in many programs; works under clinician direction.
208000000X	Family Medicine	Primary care clinicians commonly supervise and coordinate CHW activities.
208D00000X	Internal Medicine	Internal medicine clinicians supervise CHW team members for adult chronic conditions.
261QM1500X	Social Worker	Licensed clinical social workers frequently coordinate SDOH interventions alongside CHWs.
207Q00000X	Physician Assistant	PAs may supervise and integrate CHW services into the treatment plan.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`E11.9`	Type 2 diabetes mellitus without complications	Common chronic condition where SDOH barriers (food, housing, access) limit diagnosis and treatment; frequent reason for CHW involvement.
`I10`	Essential (primary) hypertension	Hypertension management is often affected by SDOH and benefits from care coordination and community supports.
`F32.9`	Major depressive disorder, single episode, unspecified	Behavioral health needs and social stressors frequently require CHW support and linkage to services.
`Z59.0`	Homelessness	Direct SDOH diagnosis that commonly triggers community health integration work to enable care.
`Z59.4`	Lack of adequate food and safe drinking water	Food insecurity is a target SDOH addressed by `G0019` interventions.
`Z59.5`	Extreme poverty	Economic instability that limits treatment adherence and access; CHWs assist with community resources.
`Z91.19`	Patient's noncompliance with other medical treatment and regimen	May be present when SDOH factors contribute to missed appointments or medication nonadherence; CHW interventions aim to improve adherence.
`Z60.0`	Social environment issues, unspecified	Captures broader social stressors relevant to SDOH assessments and care planning.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutes	Often serves as the initiating visit during which SDOH needs are identified and the supervising practitioner initiates referral to CHW services billed as `G0019`.
`99407`	Intensive tobacco cessation counseling, greater than 10 minutes	May be provided alongside CHW activities when behavioral change counseling is required to meet treatment goals.
`99401`	Preventive medicine counseling and/or risk factor reduction intervention(s) 15 minutes	Used for clinician-delivered education that the CHW contextualizes for the patient and reinforces.
`99358`	Prolonged services before and/or after direct patient care, first hour	May be billed by practitioners for additional non-face-to-face prolonged care coordination not included in `G0019` when documentation supports it.
`99490`	Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month	May be billed in concert with `G0019` when separate chronic care management services are provided and meet distinct billing requirements.

HCPCS G9490: Home Visit Assessment for Non-Homebound Patients

HCPCS-G0008-INFLUENZA-VACCINE-ADMINISTRATION

HCPCS G0008: Influenza Virus Vaccine Administration

HCPCS-G0009-PNEUMOCOCCAL-VACCINE-ADMINISTRATION

HCPCS G0009: Administration of Pneumococcal Vaccine

HCPCS-G0010-HEPATITIS-B-VACCINE-ADMINISTRATION

HCPCS G0010: Administration of Hepatitis B Vaccine

HCPCS-G0011-PREP-COUNSELING-HIV-RISK-REDUCTION-ADHERENCE

HCPCS G0011: Individual PrEP Counseling, HIV Risk Assessment

HCPCS-G0012-PRE-EXPOSURE-PROPHYLAXIS-INJECTION-HIV-PREVENTION

HCPCS G0012: Injection of Pre-Exposure Prophylaxis (PrEP) for HIV Prevention

HCPCS-G0013-PREP-INDIVIDUAL-COUNSELING-HIV-RISK-REDUCTION

HCPCS G0013: Individual PrEP Counseling and HIV Risk Assessment

HCPCS-G0017-PSYCHOTHERAPY-CRISIS-FIRST-60-MINUTES-NON-OFFICE

HCPCS G0017: Psychotherapy for Crisis, First 60 Minutes

HCPCS-G0018-PSYCHOTHERAPY-CRISIS-ADDITIONAL-30-MINUTES-NON-OFFICE

HCPCS G0018: Psychotherapy for Crisis, Additional 30 Minutes

HCPCS-G0022-COMMUNITY-HEALTH-INTEGRATION-ADDITIONAL-30-MIN

HCPCS G0022: Community Health Integration, Additional 30 Minutes

Showing 1–10 of 1996

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier — standard billing	Use when no special circumstances apply to the service.
`22`	Increased procedural services	Use if documented work or intensity substantially exceeds typical service time or complexity beyond usual G0019 activity.
`23`	Unusual anesthesia — not applicable to G0019	Rarely used; generally not applicable for non-procedural CHW services.
`29`	Substantial, separately identifiable evaluation and management service by same physician on same day	Use when the supervising practitioner provides a distinct E/M unrelated to G0019 on the same day.
`52`	Reduced services	Use if the community health integration service was started but not completed as documented.
`53`	Discontinued procedure	Use if service was discontinued due to patient or clinical circumstances before meaningful time spent.
`80`	Assistant surgeon — not applicable	Not applicable for CHW-delivered non-surgical service.
`82`	Assistant surgeon (when qualified resident unavailable) — not applicable	Not applicable to this non-procedural service.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist as primary surgeon — not applicable	Generally not used; CHW is auxiliary personnel under direction of practitioner.
`CQ`	Service provided by a registered nurse (clinical nurse specialist, nurse practitioner) — facility claims	Use when a qualifying advanced practice provider documents and bills components in facility-based billing contexts as applicable.
`QK`	Medical direction of two, three, or four concurrent anesthesia procedures — not applicable	Not applicable to G0019.
`QX`	CRNA service with medical direction — not applicable	Not applicable to G0019.
`QY`	Medical direction of one CRNA — not applicable	Not applicable to G0019.
`SH`	Physician or practitioner services rendered in a critical access hospital as telehealth originating site facility — use per payer policy	Use when service is documented and billed from an eligible originating site per payer rules.

Taxonomy Code	Specialty	Notes
373L00000X	Community Health Worker	Direct provider of `G0019` services in many programs; works under clinician direction.
208000000X	Family Medicine	Primary care clinicians commonly supervise and coordinate CHW activities.
208D00000X	Internal Medicine	Internal medicine clinicians supervise CHW team members for adult chronic conditions.
261QM1500X	Social Worker	Licensed clinical social workers frequently coordinate SDOH interventions alongside CHWs.
207Q00000X	Physician Assistant	PAs may supervise and integrate CHW services into the treatment plan.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`E11.9`	Type 2 diabetes mellitus without complications	Common chronic condition where SDOH barriers (food, housing, access) limit diagnosis and treatment; frequent reason for CHW involvement.
`I10`	Essential (primary) hypertension	Hypertension management is often affected by SDOH and benefits from care coordination and community supports.
`F32.9`	Major depressive disorder, single episode, unspecified	Behavioral health needs and social stressors frequently require CHW support and linkage to services.
`Z59.0`	Homelessness	Direct SDOH diagnosis that commonly triggers community health integration work to enable care.
`Z59.4`	Lack of adequate food and safe drinking water	Food insecurity is a target SDOH addressed by `G0019` interventions.
`Z59.5`	Extreme poverty	Economic instability that limits treatment adherence and access; CHWs assist with community resources.
`Z91.19`	Patient's noncompliance with other medical treatment and regimen	May be present when SDOH factors contribute to missed appointments or medication nonadherence; CHW interventions aim to improve adherence.
`Z60.0`	Social environment issues, unspecified	Captures broader social stressors relevant to SDOH assessments and care planning.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutes	Often serves as the initiating visit during which SDOH needs are identified and the supervising practitioner initiates referral to CHW services billed as `G0019`.
`99407`	Intensive tobacco cessation counseling, greater than 10 minutes	May be provided alongside CHW activities when behavioral change counseling is required to meet treatment goals.
`99401`	Preventive medicine counseling and/or risk factor reduction intervention(s) 15 minutes	Used for clinician-delivered education that the CHW contextualizes for the patient and reinforces.
`99358`	Prolonged services before and/or after direct patient care, first hour	May be billed by practitioners for additional non-face-to-face prolonged care coordination not included in `G0019` when documentation supports it.
`99490`	Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month	May be billed in concert with `G0019` when separate chronic care management services are provided and meet distinct billing requirements.

HCPCS G9490: Home Visit Assessment for Non-Homebound Patients

HCPCS-G0008-INFLUENZA-VACCINE-ADMINISTRATION

HCPCS G0008: Influenza Virus Vaccine Administration

HCPCS-G0009-PNEUMOCOCCAL-VACCINE-ADMINISTRATION

HCPCS G0009: Administration of Pneumococcal Vaccine

HCPCS-G0010-HEPATITIS-B-VACCINE-ADMINISTRATION

HCPCS G0010: Administration of Hepatitis B Vaccine

HCPCS-G0011-PREP-COUNSELING-HIV-RISK-REDUCTION-ADHERENCE

HCPCS G0011: Individual PrEP Counseling, HIV Risk Assessment

HCPCS-G0012-PRE-EXPOSURE-PROPHYLAXIS-INJECTION-HIV-PREVENTION

HCPCS G0012: Injection of Pre-Exposure Prophylaxis (PrEP) for HIV Prevention

HCPCS-G0013-PREP-INDIVIDUAL-COUNSELING-HIV-RISK-REDUCTION

HCPCS G0013: Individual PrEP Counseling and HIV Risk Assessment

HCPCS-G0017-PSYCHOTHERAPY-CRISIS-FIRST-60-MINUTES-NON-OFFICE

HCPCS G0017: Psychotherapy for Crisis, First 60 Minutes

HCPCS-G0018-PSYCHOTHERAPY-CRISIS-ADDITIONAL-30-MINUTES-NON-OFFICE

HCPCS G0018: Psychotherapy for Crisis, Additional 30 Minutes

HCPCS-G0022-COMMUNITY-HEALTH-INTEGRATION-ADDITIONAL-30-MIN

HCPCS G0022: Community Health Integration, Additional 30 Minutes

Showing 1–10 of 1996

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

OpenPayer

HCPCS G0019: Community Health Integration for Social Determinants of Health

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Billing Code Overview

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OpenPayer

HCPCS G0019: Community Health Integration for Social Determinants of Health

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References