Summary & Overview
HCPCS G0023: Illness Navigation and Care Coordination, Auxiliary Personnel
HCPCS Level II code G0023 covers principal illness navigation services delivered by certified or trained auxiliary personnel under clinician direction for patients with serious, high‑risk conditions. The code defines a monthly up-to-60-minute service that centers on person‑centered assessment, patient-driven goal setting, care coordination across clinicians and settings, linkage to home- and community-based supports, health education contextualized to social determinants of health (SDOH), and emotional and behavioral support. Nationally, this code matters because it formalizes reimbursement for non‑clinician navigation and coordination activities that address complex medical and social needs and can influence care continuity, avoidable utilization, and patient engagement.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an explanation of the service components, typical settings where G0023 is used, and what to expect in billing and program design. The publication summarizes payer coverage patterns, benchmark metrics where available, relevant policy developments affecting navigation and care coordination reimbursement, and clinical context on how this service integrates with team‑based care for high‑risk patients. Data not available in the input are noted where appropriate.
Clinical & Coding Specifications
Clinical Context
A 67-year-old patient with advanced congestive heart failure and multiple social needs is enrolled in a primary care practice that provides principal illness navigation services. The patient has difficulty attending appointments due to limited transportation, recently discharged from the hospital after an exacerbation, and demonstrates low health literacy. A certified patient navigator (auxiliary personnel) works under the direction of the patient's cardiologist and primary care clinician to perform a person-centered assessment, document social determinants of health needs (housing instability, food insecurity, transportation barriers), and establish patient-driven goals such as medication adherence and timely outpatient follow-up. Over a 60-minute calendar month period the navigator coordinates scheduling with the cardiology clinic, arranges non-emergency medical transportation, communicates discharge needs to the skilled nursing facility, refers the patient to community-based meal services, provides tailored education that contextualizes the clinician’s treatment plan to the patient’s goals, and supports self-advocacy skills for interactions with the care team. The workflow includes initial intake and assessment, development of an action plan with the clinician, ongoing telephone and portal outreach, documentation in the electronic health record, coordination with home- and community-based service providers, and follow-up after emergency department visits or subsequent hospital discharge.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier specified (default) |