Medicare Billing

Community Health Integration (CHI) Services

Medicare reimburses CHI services only when billed by an eligible Medicare practitioner. CHWs and CHRs generally do not bill Medicare directly.

Key billing considerations include:

Services must be ordered by an eligible billing practitioner.
The beneficiary must meet Medicare eligibility requirements.
Services are provided under the general supervision of the billing practitioner.
Documentation must support medical necessity and time requirements.
Services are billed using CMS-designated HCPCS codes.

Organizations should review current CMS guidance and Medicare Administrative Contractor (MAC) policies for the most up-to-date billing requirements.

Like CHI services, PIN services are billed by an eligible Medicare practitioner rather than by the CHW or CHR.

Successful billing requires:

Practitioner oversight and general supervision.
Appropriate patient consent, when required.
Documentation demonstrating medical necessity and services provided.
Compliance with CMS billing requirements, including applicable HCPCS codes and time thresholds.
Coordination between the CHW or CHR and the billing practitioner to ensure complete documentation.

Organizations should verify current CMS guidance and payer requirements, as billing policies may be updated over time.