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Geisinger Health PlanMedicaid · Billing Codes · Claims · PA · Family Medicine, Internal Medicine, Pediatrics +3 moreHigh impact

Community Health Worker (CHW) billing update

Act
by Jan 1, 2026
Effective date
Jan 1, 2026
Identified
Jul 29, 2026

Summary

Effective January 1, 2026, GHP Family now allows certified Community Health Workers (CHWs) to bill for services using procedure code G0019 at $27.98 per unit, limited to 3 visits per member per year. CHWs must obtain Pennsylvania certification, PROMISe ID enrollment, and DHS enrollment at each service location. Billing team must implement new code workflows, documentation requirements, and visit limits to ensure compliance.

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What to do

by Jan 1, 2026 · 10 steps
01Billing team must configure billing system to accept procedure code G0019 at flat rate of $27.98 per unit.
02Implement automated visit limit edits to block billing beyond 3 visits per member per year and flag denials as provider responsibility.
03Update claim submission templates to require CHW certification verification and PROMISe ID documentation before processing.
04Clinical staff must verify that CHW services are ordered by eligible practitioners (physician, LCSW, CNM, etc.) and condition is on approved list (asthma, COPD, diabetes, heart disease, hypertension, obesity, etc.).
05EMR/documentation team must add mandatory fields to CHW visit records: date, time, duration, location, and intervention summary.
06Confirm CHW and supervising provider DHS enrollment at each location where services are rendered.
07Verify PROMISe ID is linked to billing location and supervising provider.
08Exclude non-covered services from billing: transportation, housing assistance, case management, childcare, and others in Exhibit B(5b) of 2026 HealthChoices contract.
09Failure to implement visit limits will result in claim denials for visits 4+ being provider responsibility.
10Contact GHP Provider Services (800-876-5357) for questions.

Codes mentioned

G0019

Original notice

Community Health Worker (CHW) billing update
geisinger.org · Always check the source before changing claims.
View original ↗

Related policy hubs

Geisinger Health Plan policiesPA policy changesFamily MedicineInternal MedicinePediatricsCardiologyPulmonologyEndocrinologyCode G0019

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