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CMS introduced PIN billing codes in 2024 to reimburse cancer patient navigation services — but a UAB study shows the system isn't delivering. Across 500 paid claims, total revenue was just $26,291, 38% of claims were rejected or pending, and reimbursements barely scratched the surface of actual program costs. Researchers say small policy tweaks could make a big difference.
When CMS rolled out Principal Illness Navigation (PIN) billing codes in 2024, it was hailed as a landmark step toward reimbursing cancer patient navigation services. But a real-world study from the University of Alabama at Birmingham (UAB) reveals a significant gap between policy intent and financial reality.
Of 7,292 patients who received navigation services in 2025, only 12% generated an eligible initial PIN claim — and just 11% of those had a second claim the following month. Total revenue from 500 paid claims came to $26,291, an amount Dr. Gabrielle B. Rocque described as "not even enough to cover 1 navigator" for a program employing 66.
By the Numbers:
Why it matters: Patient navigation improves outcomes for cancer patients, but without sustainable reimbursement, programs risk collapse. Dr. Rocque's top recommendations — higher payments, removing the tie to the initial physician visit, eliminating separate consent requirements, and scrapping out-of-pocket costs — could help turn a promising policy into a workable one.
