Unlocking Navigation Reimbursement Opportunities

The Centers for Medicare and Medicaid Services (CMS) officially started rolling out reimbursement for patient navigation services last year; this marks a historic victory for patients, healthcare providers, and organizations like Azra AI that champion better, more equitable care. 

As of January 1, 2024, CMS has implemented new billing codes—G0023, G0024, G0140, and G0146—specifically for Principal Illness Navigation (PIN) services. These codes reimburse providers for offering individualized support to patients with serious, high-risk conditions requiring complex, coordinated care.  

For the first time, health systems can receive sustainable reimbursement for the work that navigators have long done behind the scenes, guiding patients through the fragmented U.S. healthcare system. 

Why Reimbursement Matters: Building a Sustainable Workforce for the Future 

Before this ruling, navigation programs relied heavily upon philanthropy, grants, or discretionary health system dollars. This led to inconsistencies in access—especially in underserved areas. By making navigation reimbursable, CMS is creating a predictable financial model that will help build, professionalize, and sustain this critical workforce. 

“This truly is a major step forward toward improving outcomes from cancer,” said Karen Knudsen, CEO of the American Cancer Society. 

We agree. That’s why Azra AI is committed to helping health systems operationalize this win, turning policy into practice, and practice into better outcomes. 

At Azra AI, we’re proud to be at the forefront of this transformative moment in healthcare. Our technology is built to help health systems not only identify patients who need navigation but also to enable and optimize billing for navigation services through seamless integration and smart automation. 

Azra AI’s Role: Automating and Enabling Reimbursement 

As the leader in AI-powered navigation support, Azra AI helps health systems operationalize this opportunity with intelligent automation, real-time insights, and seamless billing enablement. Here's how: 

1. Real-Time Patient Identification 

Our platform uses statistical natural language processing (NLP) and advanced transformer-based AI models to surface patients with incidental or suspected cancer findings, high-risk screening results, and newly diagnosed cancer patients. This allows navigators to engage early—at the moment it matters most—and begin completing and documenting navigation activities eligible for billing under CMS’s new PIN codes. 

2. Billing Support & Documentation 

Our software captures and organizes the necessary details to meet CMS billing requirements, including: 

• Time tracking of navigation activities 

• Documentation of care plan development 

• Coordination across specialties 

• Non-clinical support services provided by credentialed navigators 

• Patient Consent and Evaluation and Management visit 

Our platform integrates easily with EHRs and existing workflows, reducing administrative burden while maximizing reimbursement potential. 

3. Credentialing Awareness & Integration 

CMS requires that navigators delivering reimbursable PIN services be appropriately trained and credentialed. We support alignment with recognized credentialing programs like the ACS Leadership in Oncology Navigation (LION) program, ensuring our clients are eligible, compliant, and audit-ready. 

The Opportunity Ahead: Expand Access, Drive Outcomes, Capture Revenue 

At Azra AI, we believe no patient should fall through the cracks. Now, with CMS formally recognizing the vital role of navigation, health systems have the opportunity to formalize, fund, and scale these services in a sustainable way. 

With Azra AI’s intelligent automation and reimbursement support, you can: 

• Expand access to navigation services: Identify patients earlier in their journey and ensure no one falls through the cracks — even in high-volume or resource-constrained environments. 

• Ensure compliance with CMS billing requirements: Capture all required documentation seamlessly and accurately, reducing audit risk and making sure you’re reimbursed for every eligible service. 

• Reduce navigator burnout by streamlining manual processes: Free your navigators from time-consuming paperwork so they can focus on what matters most — helping patients. 

• Improve care coordination and patient outcomes: Deliver more timely, better coordinated care with visibility across teams and touchpoints — from suspicion to survivorship. 

• Capture the reimbursement you deserve for providing exceptional care: Support and scale the vital work of your navigators with a reimbursement model that honors both care and sustainability. 

Azra AI turns policy change into real change — for patients, providers, and the future of healthcare. Contact us today to learn how we can help your organization unlock sustainable reimbursement and transform navigation services at scale.