The 2024 and 2025 Physician Fee Schedule Final Rules advanced significant policy changes for Medicare payments under the PFS and other Medicare Part B payment policy issues including coding and payment changes for Community Health Integration (CHI), Social Determinants of Health (SDOH) Risk Assessment, and Principal Illness Navigation (PIN)–services to address Health-Related Social Needs (HRSNs) services.
These services codes, which were established in 2024 and updated in 2025, provide a direct pathway for reimbursement for the labor extended by auxiliary personnel, including community health workers, to the Medicare provider. In addition, they allow providers to contract with community-based organizations that can provide staffing to address identified HRSNs and the health navigation of affected populations.
To support community-based organizations and healthcare providers in the delivery of reimbursable CHI and PIN services, the Partnership and Freedmen’s Health Consulting have developed and disseminated numerous resources. Partnership and FHC have also hosted a webinar series, Addressing HRSNs Through Medicare: An Update on CY 2025 Changes and Implementation Activity for Community Health Integration and Principle Illness Navigation (CHI/PIN) Codes.
The January 22 webinar provided an overview of the codes and updates that were included in the CY 2025 Fee Schedule. The January 29 event featured a panel discussion among several organizations that are currently exploring and implementing billing and reimbursement opportunities through CHI and PIN. Both webinars are of interest to cross-sector health care and social care stakeholders who want to learn more about these codes and to hear from peers who are engaged in implementation activities.
Partnership to Align Social Care Resources:
- NEW Webinar Series, Addressing HRSNs Through Medicare: An Update on CY 2025 Changes and Implementation Activity for Community Health Integration and Principal Illness Navigation (CHI/PIN) Codes
- January 29 Recording and Slides (pdf)
- January 22 Recording and Slides (pdf).
- CY 2025 Physician Fee Schedule
- Letter responding to the CMS request for information regarding barriers to implementing codes to address HRSNs (pdf)
- Letter responding to updates needed and proposed changes to telehealth flexibilities, Caregiver Training Services (CTS), ACO quality measures re: HRSN screening; and the Advanced Primary Care Model (APCM) (pdf)
- Template language for stakeholders to consider incorporating into organizational/individual comments on the proposed rule (Word doc for download)
- September 4, 2024 recording discussing sign-on requests and letter components
- Stakeholder Calls, August 2024
- August 6 Recording and Slides (pdf). Discussion included a brief review of the CY2024 PFS Final Rule re: HRSNs codes, an overview of the CY2025 PFS Proposed Rule request for information re: CHI/PIN codes, and addressed FAQs.
- August 14 Recording and Slides (pdf). Discussion included an overview of submission guidelines, potential responses to the RFI re: CHI/PIN codes, the Advanced Primary Care Model RFI, and Q&A. Other resources discussed include Aging and Disability Business Institute guides to Insurance in Contracting, Becoming a Medicare Provider, and Model Contracts for CBO Networks (including CCHs)
- Webinar: What Does the CY 2025 Medicare Physician Fee Schedule Proposed Rule Mean for Addressing HRSNs?, July 30, 2024
- Webinar Recording
- Slides (pdf)
- Resources List (pdf)
- Understanding the Medicare Physician Fee Schedule Billing Codes for: Community Health Integration (CHI), Principal Illness Navigation (PIN), and Principal Illness Navigation – Peer Support (PIN-PS) Services–A Primer (pdf)
- Webinar: Community Health Integration and Principal Illness Navigation Medicare Codes, April 3, 2024
- Webinar Recording
- Slides (pdf)
- Webinar: The Medicare Physician Fee Schedule (PFS) Includes Codes to Address HRSNs…What Happens Next?, November 15, 2023
- Webinar Recording
- Slides (pdf)
- Templates
Freedmen’s Health Consulting Resources:
- Pathways to Payment: https://communityhealthintegration.info/
Administration Resources:
- Final CY 2025 Medicare Physician Fee Schedule: https://www.govinfo.gov/content/pkg/FR-2024-12-09/pdf/2024-25382.pdf
- CMS FAQ re: Health Related Social Needs: https://www.cms.gov/files/document/health-related-social-needs-faq.pdf
- CMS Medicare Learning Network Booklet, Health Equity Services in the 2024 Physician Fee Schedule Final Rule
- Link to Final Rule: https://www.federalregister.gov/documents/2023/11/16/2023-24184/medicare-and-medicaid-programs-cy-2024-payment-policies-under-the-physician-fee-schedule-and-other
- CMS PFS Final Rule Fact Sheet: https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2024-medicare-physician-fee-schedule-final-rule
- Press Release Detailing Efforts to Advance Health Equity: https://www.cms.gov/newsroom/press-releases/cms-finalizes-physician-payment-rule-advances-health-equity
- Press Release Detailing Behavioral Health Care Provisions: https://www.cms.gov/newsroom/press-releases/cms-makes-hospital-prices-more-transparent-and-expands-access-behavioral-health-care