HCPCS G0024: Principal Illness Navigation, Additional 30 Minutes - OpenPayer

Summary & Overview

HCPCS G0024: Principal Illness Navigation, Additional 30 Minutes

HCPCS Level II code G0024 denotes an additional 30 minutes per calendar month of principal illness navigation services, billed separately in addition to G0023. The code covers time-based care coordination focused on managing a patient’s primary illness, typically delivered in outpatient or ambulatory settings, including clinic-based coordination and telephonic or virtual navigation encounters. Nationally, such navigation codes matter because they formalize reimbursement for non-face-to-face care coordination work that supports chronic disease management, discharge planning, and continuity of care.

Key payers referenced in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code’s clinical intent, typical sites of service, and how it is positioned relative to the base navigation service G0023. The publication also covers common billing contexts, applicable modifiers (listed separately), and areas where data was not provided.

This summary equips billing managers, practice administrators, and policy analysts with the essential context needed to recognize when G0024 applies, how it complements other navigation services, and what national payers commonly cover. Data not available in the input is noted where applicable; the piece focuses on descriptive and policy-relevant information rather than specific state-level guidance or utilization metrics.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG0024HCPCS Level IIillness navigationcare coordinationtime-based servicesoutpatient servicesbilling guidancehealthcare policy

Billing Code Overview

HCPCS Level II code G0024 represents principal illness navigation services, additional 30 minutes per calendar month. This code is intended to be billed in addition to G0023 when a patient requires an extra 30 minutes of navigation focused on managing a principal illness within the same calendar month.

Service Type: Illness navigation / care coordination time-based service

Typical Site of Service: Outpatient or ambulatory care settings, including clinic-based care coordination and telephonic or virtual navigation encounters

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult with a complex chronic illness (for example, congestive heart failure or metastatic cancer) who requires ongoing case management and care coordination. The primary care practice or a specialty care clinic provides principal illness navigation services delivered by a clinician or a qualified non-physician practitioner (such as a nurse care manager or social worker with appropriate billing taxonomy) to support medication management, scheduling of specialty visits, coordination of home health or durable medical equipment, and addressing barriers to care. After an initial monthly care navigation encounter billed as G0023 (principal illness navigation services, first 30 minutes per calendar month), additional documented time for another 30-minute block within the same calendar month is billed as G0024.

Workflow: A patient contacts the clinic with worsening symptoms and difficulty managing multiple appointments. The care manager reviews the patient chart, communicates with the treating cardiologist, arranges a home health visit, and documents 30 additional minutes of direct coordination (telephone calls, messaging, care plan updates) beyond the initial G0023 time. The service is documented in the medical record with start/stop times, the issues addressed, parties contacted, and the rationale for additional time. The claim uses G0024 with appropriate modifiers as needed to reflect location, provider role, or unusual circumstances.

Coding Specifications

Modifier	Description

HCPCS G0519: Management of New Patient-Caregiver Dyad with Dementia, Low Complexity

HCPCS-G9057-ONCOLOGY-GUIDELINE-DEVIATION-CLINICAL-TRIAL

HCPCS G9057: Oncology Guideline Deviation for Clinical Trial Enrollment

HCPCS-G0313-IMMUNIZATION-COUNSELING-UNDER-21-16-30-MINS

HCPCS G0313: Immunization Counseling for Patients Under 21, 16–30 mins

HCPCS-G9359-TB-SCREEN-CLEARANCE-BEFORE-BIOLOGIC-THERAPY

HCPCS G9359: TB Screening and Clearance Prior to Biologic Therapy

HCPCS-G0069-SUBCUTANEOUS-IMMUNOTHERAPY-HOME-ADMINISTRATION-15-MIN

HCPCS G0069: Subcutaneous Immunotherapy/Infusion Administration in Home, per 15 min

HCPCS-G2175-COMORBID-CONDITION-EPISODE

HCPCS G2175: Episode with Comorbid Condition

HCPCS-G9836-REASON-TRASTUZUMAB-NOT-ADMINISTERED

HCPCS G9836: Reason for Not Administering Trastuzumab

HCPCS-G9832-BREAST-CANCER-STAGE-I-T1C

HCPCS G9832: AJCC Stage I (T1c) at Breast Cancer Diagnosis

HCPCS-G9303-MISSING-PROSTHETIC-IMPLANT-SPECIFICATIONS

HCPCS G9303: Operative Report Missing Prosthetic Implant Specifications

HCPCS-G9783-DIABETES-LDL-C-UNDER-70-NO-STATIN-THERAPY

HCPCS G9783: Diabetes Patients with LDL-C <70 mg/dL Not on Statin Therapy

Showing 1–10 of 1996

Taxonomy Code	Specialty	Notes
`361QP0800X`	Case Management	Typical providers delivering principal illness navigation services and care coordination.
`163WX0001X`	Nurse Practitioner	Nurse practitioners commonly provide and bill for care navigation under appropriate supervision and payer rules.
`207Q00000X`	Family Medicine	Primary care physicians overseeing chronic disease management and navigation services.
`207R00000X`	Internal Medicine	Internists coordinating specialist referrals and chronic care resources.
`2083N0400X`	Hospice and Palliative Medicine	Specialists frequently involved when advanced illness navigation and symptom management are primary goals.

ICD-10 Code	Description	Clinical Relevance
Data not available in the input.	Data not available in the input.	Data not available in the input.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99487`	Complex chronic care coordination services, first hour of clinical staff time directed by a physician or other qualified health care professional per calendar month, with moderate or high complexity medical decision making	Often provided in the same care management ecosystem; `99487` may be billed for clinical CCM services that overlap with navigation but have distinct billing rules and time thresholds.
`99489`	Each additional 30 minutes of clinical staff time directed by a physician or other qualified health care professional per calendar month (List separately in addition to `99487`)	Analogous to `G0024` as an additional time increment for chronic care management; used when time exceeds the base service.
`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 for lower-intensity monthly coordination; practices choose between CCM (`99490` series) and principal illness navigation (`G0023`/`G0024`) based on payer rules.
`99495`	Transitional care management services with moderate medical decision complexity, face-to-face visit within 14 days	Transitional services often precede or follow navigation activities to ensure continuity after hospital discharge.
`99354`	Prolonged service in the office or other outpatient setting requiring direct patient contact beyond the usual service; first hour	Prolonged face-to-face care time that may occur in conjunction with navigation activities when direct visits extend beyond typical visit times.

`22`	Increased procedural services	Use when `G0024` represents substantially greater intensity or time than typical and documentation supports increased complexity beyond the usual navigation service.
`23`	Unusual anesthesia	Not typically applicable; only used if unusual anesthesia circumstances directly affect the navigation service (rare).
`52`	Reduced services	Use when fewer services than described were furnished but still warrant partial payment for `G0024`.
`53`	Discontinued procedure	Use if the navigation service was discontinued after initiation and documentation supports termination before completion.
`62`	Two surgeons	Use when two clinicians share principal responsibility for coordination and payer policy allows this modifier for shared navigation responsibility.
`78`	Unplanned return to the operating/procedure room	Not typical for navigation services; rarely used.
`80`	Assistant at surgery	Not applicable to `G0024` in routine use; avoid unless payer instructions permit.
`AS`	Physician assistant or advanced practice clinician as secondary surgeon	Use when the service is performed or supervised by an advanced practice clinician and payer requires this modifier for payment clarity.
`QX`	Ordering/servicing clinical staff split/shared; modifier for assistant or QPP related billing	Use when applicable per payer rules for split/shared services involving non-physician practitioners contributing to the navigation time.
`TG`	Monitored anesthesia care direction of service by anesthesiologist	Not applicable to `G0024`; include only if payer-specific rules require.

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