04/17/2024

CMS Payment for Principal Illness Navigation: How Do I Credential My Navigators?

Following decades of research demonstrating efficacy of patient navigation, the Centers for Medicare & Medicaid Services (CMS) established a rule to reimburse for patient navigation services for Medicare beneficiaries on January 1, 2024. This paper outlines how to credential your navigation team to ensure that you are set up for payment under the new G-codes for patient navigation. We outline a variety of ways to document that your navigation team is appropriately credentialed. We include what the CMS rule says and does not say in terms of credentialing and standards, and we include evidence-based, free resources to bolster your navigation team’s foundational knowledge base in preparation for using the new billing codes.

Following decades of research demonstrating efficacy of patient navigation, effective January 1, 2024, the Centers for Medicare & Medicaid Services (CMS) started paying for patient navigation under the CY 2024 Payment Policies under the Physician Fee Schedule.

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