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    OpenPayerBilling CodesProcedures / Professional ServicesHCPCS hcpcs-g0019-community-health-integration-sdoh-care-coordination
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    HCPCS G0019: Community Health Integration, Person-Centered Assessment

    Medicare pays $89 on average nationally for this procedure.

    HCPCS Level II code G0019 describes community health integration services delivered by certified or trained auxiliary personnel (for example, a community health worker) under a physician or practitioner’s direction, billed for 60 minutes per calendar month to address social determinants of health that significantly limit diagnosis or treatment; service type: person-centered assessment, care coordination, health education, goal-setting, facilitation of access to community resources, behavioral support, and advocacy; typical site of service: community, home, outpatient clinic, or other non-acute settings where social needs and transitions of care are addressed.

    For related coverage guidance, see recent payer policy updates: Percutaneous Electrical Nerve Field Stimulation for Functional Abdominal Pain Disorders, Esophagogastroduodenoscopy (EGD) Coverage Policy, Radiofrequency Therapy for Fecal Incontinence.

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    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.

    Related CPT Codes

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

    Related Modifiers

    6 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
    82Modifier 82 is appended to a surgical CPT code to indicate that an attending physician acted as an assistant because a qualified resident surgeon was unavailable. In teaching hospitals it documents…- When to use: Append modifier 82 in teaching-hospital settings to indicate a physician served as an assistant surgeon because a qualified resident surgeon was unavailable (includes situations where…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    208000000X
    208D00000X
    207Q00000X
    320600000X
    125J00000X
    101YA0400X
    2081P0010X
    207RM1200X

    Related Payer Policy Updates

    Specialty: Gastroenterology1 / 3

    10 rows

    PolicyPayerEffective Date
    Percutaneous Electrical Nerve Field Stimulation for Functional Abdominal Pain Disordersbcbsvermont2026-12-01
    Esophagogastroduodenoscopy (EGD) Coverage Policyevicore2026-11-05
    Radiofrequency Therapy for Fecal IncontinenceCigna2026-10-15
    Magnetic Sphincter Augmentation for the Treatment of Gastroesophageal Reflux Disease (GERD)univerahealthcare2026-10-15
    High-Resolution Anoscopy (HRA)Premera Bluecross2026-10-01
    Gastroesophageal and Gastrointestinal (GI) Services and ProceduresColorado Rocky Mountain Health Plans2026-10-01
    Fecal Analysis in the Diagnosis of Intestinal Dysbiosis and Fecal Microbiota Transplant TestingOscar Health2026-10-01
    Serum Testing for Hepatic Fibrosis in the Evaluation and Monitoring of Chronic Liver DiseaseOscar Health2026-10-01
    Pancreatic Enzyme Testing for Acute PancreatitisOscar Health2026-10-01
    Helicobacter pylori TestingOscar Health2026-10-01

    Related Codes

    HCPCS-G9490-HOME-ASSESSMENT-NON-HOMEBOUND

    HCPCS G9490: Home Visit Patient Assessment for Non-Homebound Beneficiary

    HCPCS-G0008-INFLUENZA-VACCINE-ADMINISTRATION

    HCPCS G0008: Administration of Influenza Virus Vaccine

    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 PrEP Drug for HIV Prevention

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

    HCPCS G0013: Individual PrEP Counseling by Clinical Staff

    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

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    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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