HRSN Codes Implementation Resources

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Resources Available to Implement Services to Address Health-Related Social Needs (HRSNs) in Medicare and Beyond

The Partnership to Align Social Care is developing a number of resources intended to help health and social care stakeholders implement opportunities inherent in Medicare billing codes to address health-related social needs (HRSNs).

Recently, the Partnership submitted two comments to CMS regarding the CY2025 Medicare Physician Fee Schedule proposed rule, which could mean additional significant changes for services to address HRSNs.

 

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The CY2024 Physician Fee Schedule Final Rule, effective January 1, 2024, includes significant policy changes for Medicare payments under the PFS and other Medicare Part B payment policy issues. The rule includes significant coding and payment changes for services to address HRSNs including Community Health Integration (CHI), Social Determinants of Health (SDOH) Risk Assessment, and Principal Illness Navigation (PIN) services.

There are also provisions to support Medicare providers contracting with community care hubs (CCHs) and community-based organizations (CBOs) to address HRSNs for priority populations. These codes are the first that are specifically designed to describe services involving community health workers, care navigators, and peer support specialists, and that allow these services to be provided by personnel employed by CCHs/CBOs under the general supervision of the billing practitioner.

The Partnership and Freedmen’s Health Consulting are collaborating to develop a series of resources to help stakeholders implement these  billing codes. More information about those resources is below including a recording of a webinar event to discuss the recently released report, 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. 

Policy updates were also proposed in the CY2025 Medicare Physician Fee Schedule. The Partnership hosted a webinar detailing what the proposed rule would mean for HRSNs and two stakeholder calls to discuss these important potential policy updates, and sent two sign-on letters to CMS in response to the proposed rule.

Partnership to Align Social Care Resources: 

Freedmen’s Health Consulting Resources:

Administration Resources: