In 2024, CMS introduced new CPT and HCPCS codes that permit billing for cancer patient navigation services delivered by licensed healthcare providers (physicians, physician assistants, nurse practitioners) or supervised staff (navigators, nurses, medical assistants, etc.). These time-based codes are billable monthly—even during the global period—and cover services delivered in person, by phone, or via telehealth.
Patient navigation is a vital, patient-centered service that helps individuals overcome barriers to timely diagnosis, treatment, and support. It’s especially critical in fragmented healthcare systems for high-stakes conditions like cancer.
Patient Navigation:
Improves the speed and quality of cancer care
Boosts treatment initiation by 70%
Improves treatment adherence by 71%
Reduces social determinants of health (SDOH) barriers, which drive 80% of health outcomes
Helps meet Commission on Cancer quality metrics (e.g., treatment initiation <60 days)
CMS recognized the evidence about patient navigation:
Navigation improves outcomes by reducing delays and enhancing treatment adherence.
It supports value-based care by rewarding coordination—not just procedures.
It legitimizes “invisible work”-non-face-to-face care, previously unreimbursable until now.
It advances equity, especially for underserved populations.
It ensures sustainability, enabling practices to fund or grow navigation programs.
In the early months of cancer care, oncology practices regularly provide 6-8 hours of patient navigation service per patient - typically delivered in 5–30-minute increments. Until now, this essential work has gone largely uncompensated. However, with the introduction of new patient navigation CPT and HCPCS codes, cancer providers and programs can now bill for these services - generating more than $50,000 in annual revenue per provider for work they and their teams are already doing. This includes scheduling procedures and tests, tracking down results, reviewing test results, managing prior authorizations and peer-2-peers, coordinating referrals, performing language interpretation, completing disability forms, arranging transportation, survivorship planning, and so much more.
Despite this revenue opportunity, the real challenge for providers and their staff is how to conveniently track, document, and bill for each of these navigation encounters. That’s where XpediteMD helps.
XpediteMD is a cloud-based, integratable digital navigation and oncology care platform that simplifies encounter tracking, documentation, coding, and billing for patient navigation—turning navigation from a cost center into a revenue stream.
In 2024, CMS introduced four new categories of CPT and HCPCS codes specifically designed to support billing for cancer patient navigation services: Principal Care Management (PCM), Principal Illness Navigation (PIN), Community Health Integration (CHI), and Social Determinants of Health(SDOH) Assessment (see pages 5-9 for reference).
PCM Codes apply to patient navigation provided by physicians, nurse practitioners, physicianassistants, and oncology-certified nurses.
PIN Codes reimburse navigation services performed by patient navigators and other auxiliary clinical staff, such as trained medical assistants, registered nurses, care coordinators, socialworkers, and nutritionists.
CHI Codes are intended for navigation services delivered by community health workers and auxiliary personnel supporting care integration in underserved populations.
These codes formally recognize and reimburse the multidisciplinary coordination required to deliver high-quality, patient-centered cancer care.
1. Care Coordination
Arranging and managing referrals to specialists, other healthcare services (e.g., cardiology, nephrology), and community services
Coordinating follow-up appointments or diagnostic tests necessary for the condition, and coordinating transitions of care (e.g., hospital discharge)
Ensuring communication between multiple providers involved in the patient’s care plan
Preparation, presenting and discussion of patient at tumor board presentations
2. Patient Education and Engagement
Teaching patients (and caregivers) about their chronic condition, treatment plan and goals
Providing guidance on lifestyle changes, self-monitoring, diet, exercise, treatment adherence, and medication compliance
Supporting shared decision-making
3. Medication Management and Reconciliation
Helping patients understand their medications, including dosing, timing, and side effects
Identifying issues such as medication duplication, omissions, or adherence challenges
Coordinating with pharmacists and providers to reconcile medications
4. Monitoring and Reviewing the Care Plan
Regularly evaluating patient progress toward health goals
Tracking patient compliance with treatment plans
Updating the care plan based on new clinical information or patient feedback
Reviewing results of diagnostic tests, lab results, and other health data related to the condition
5. Addressing Social Determinants of Health (SDOH)
Helping patients overcome barriers such as transportation, housing, food insecurity, or financial constraints that impact care adherence
Connecting patients to relevant community resources and support services (e.g., food banks,transportation assistance programs)
Assisting with applications for financial aid, insurance coverage, or prescription assistance programs
6. Communication and Check-ins
Providing ongoing communication via phone calls, secure messaging, or in-person interactions tomonitor the patient’s progress
Following up after emergency room visits or hospital discharges
Offering reminders for upcoming appointments, screenings, monitoring, or medication reminders
Identifying gaps in care and proactively reaching out to address patient needs
7. Patient Advocacy
Supporting patients in communicating with providers and advocating for their needs
Assisting with understanding and resolving medical bills and insurance coverage issues
Acting as a liaison between the patient and healthcare providers
8. Psychosocial and Emotional Support
Offering emotional support or referrals for mental health resources
Identifying signs of depression, anxiety, or caregiver strain
Promoting overall well-being
9. Survivorship Planning
Summarizing diagnosis and treatment
Establishing a plan for follow-up, future medical care, surveillance, and tests
Managing late and long-term side effects
1. Person-centered assessment
Conducting an assessment to understand the patient's life story, strengths, needs, goals, preferences,and desired outcomes, including cultural and linguistic factors and unmet SDOH needs
Facilitating patient-driven goal setting and establishing an action plan
Providing tailored support to the patient as needed to accomplish the practitioner's treatment plan
2. Supportive services
Identifying or referring patient (and caregiver or family, if applicable) to appropriate supportive services
3. Care coordination
Coordinating receipt of needed services from healthcare practitioners, providers, and facilities; home-and community-based service providers; and caregiver (if applicable)
Coordinating tests and follow-up visits
Ensuring all members of care team are aligned on the care plan
Communicating with practitioners, home-, and community-based service providers, hospitals, and skilled nursing facilities (or other health care facilities) regarding the patient's psychosocial strengths and needs, functional deficits, goals, preferences, and desired outcomes, including cultural and linguistic factors
Coordinating care transitions between and among health care practitioners and settings, including transitions involving referrals to other clinicians; follow-ups after an emergency department visit or discharges from hospitals, skilled nursing facilities, or other healthcare facilities
Facilitating access to community-based social services (e.g., housing, utilities, transportation, foodassistance) to address SDOH need(s)
4. Health education
Helping the patient contextualize health education provided by the patient's treatment team with the patient's individual needs, goals, preferences, and SDOH need(s), and educating the patient (and caregiver, if applicable) on how to best participate in medical decision-making
5. Building self-advocacy skills
Empowering the patient to interact effectively with the healthcare team and related community-based services in ways that are more likely to promote personalized and effective diagnosis or treatment
6. Health care access/health system navigation
Helping the patient access health care, including identifying appropriate practitioners or providers for clinical care, and helping secure appointments with them
Communicating with insurance providers to submit prior authorization forms; gathering and submitting clinical documentation; tracking authorization status and relaying updates, resolving delays and denials; Peer-2-Peer
7. Monitoring and Reviewing Care Plan
Regularly evaluating patient progress toward health goals
Tracking key health indicators (e.g., blood pressure, blood sugar)
Updating the care plan based on new clinical information or patient feedback
8. Addressing Social Determinants of Health (SDOH)
Identifying barriers to care, such as transportation, housing, food insecurity, or cost of medications
Connecting patients to relevant community resources and support services
9. Facilitating behavioral change
Facilitating behavioral change as necessary for meeting diagnosis and treatment goals, includingpromoting patient motivation to participate in care and reach person-centered diagnosis ortreatment goals
10. Providing social and emotional support:
Helping the patient cope with their medical conditions, SDOH need(s), and adjust daily routines to better meet treatment goals
Leveraging knowledge of the serious, high-risk condition and/or lived experience, when applicable, to provide support, mentorship, or inspiration to meet treatment goals
1. Person-centered assessment
Conducting an assessment to understand the patient's life story, strengths, needs, goals, preferences, desired outcomes, and unmet SDOH need(s), including cultural and linguistic factors
Facilitating patient-driven goal setting and establishing an action plan
Providing tailored support to the patient as needed to accomplish the practitioner's treatment plan
2. Practitioner, home-, and community-based care coordination
Coordinating receipt of needed services from healthcare practitioners, providers, and facilities; home- and community-based service providers, social service providers, and caregiver (if applicable)
Communicating with practitioners, home- and community-based service providers, hospitals, and skilled nursing facilities (or other health care facilities) regarding the patient's psychosocial strengths and needs, functional deficits, goals, preferences, and desired outcomes, including cultural and linguistic factors
Coordinating care transitions between and among health care practitioners and settings, including transitions involving referral to other clinicians; follow-up after an emergency department visit; or follow-up after discharges from hospitals, skilled nursing facilities, or other health care facilities
Facilitating access to community-based social services (e.g., housing, utilities, transportation, foodassistance) to address the SDOH need(s)
3. Health education
Helping the patient contextualize health education provided by the treatment team in light of their individual needs and SDOH, and educating the patient on how to best participate in medical decision-making
4. Building self-advocacy skills
Empowering the patient to interact effectively with the healthcare team and related community-based services addressing SDOH need(s), in ways that are more likely to promote personalized and effective diagnosis or treatment
5. Health care access/health system navigation
Assisting the patient in accessing healthcare, including identifying appropriate practitioners and securing appointments with them.
6. Facilitating behavioral change
Facilitating behavioral change as necessary for meeting diagnosis and treatment goals, including promoting patient motivation to participate in care and reach person-centered diagnosis or treatment goals
7. Providing social and emotional support
Facilitating and providing social and emotional support to help the patient cope with the problem(s) addressed in the initiating visit, the SDOH need(s), and adjusting daily routines to better meet diagnosis and treatment goals
Leveraging lived experience when applicable to provide support, mentorship, or inspiration to meet treatment goals
See how much revenue / wRVU you can make a year from navigation activities with our simple Navigation Revenue Calculator.
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See how much revenue / wRVU you can make a year from navigation activities with our simple Navigation Revenue Calculator.
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