Introduction

This plain‑language FAQ explains how Medicare and Medicare Advantage cover Aviator Health’s care navigation, what you might pay out of pocket, how prior authorizations and appeals work, and what you’ll see on your Explanation of Benefits (EOB). All details reflect federal rules in effect since January 1, 2024 (with specific 2025 updates noted). For definitions and billing rules on Principal Illness Navigation (PIN), see the American Academy of Family Physicians’ overview and the Rural Health Information Hub synopsis. For background on related SDOH/CHI reimbursement, see Patient Navigator Training’s policy update. AAFP on PIN codes • Rural Health Information Hub on PIN • PNCT on 2024 Medicare navigation reimbursement

Who delivers the service and who bills it?

• Aviator Health pairs you with a dedicated Healthcare Navigator (e.g., nurse, care coordinator, community health worker) for ongoing support. About Aviator

• Clinical services are delivered via Aviator Medical Group PA; Oxbow Health Inc. operates the platform and provides administrative support but does not practice medicine. Terms of Use • HIPAA Notice

• Claims for navigation under Medicare are billed by the eligible practitioner who performs the “initiating visit” and supervises auxiliary personnel (navigators). AAFP on PIN codes

Does Medicare cover healthcare navigation?

Yes. Since January 1, 2024, Traditional Medicare pays for Principal Illness Navigation (PIN) services for patients with serious or high‑risk conditions (e.g., cancer, COPD, CHF, dementia, SMI/SUD). Services include person‑centered planning, care coordination, navigation to clinical/community resources, and patient self‑advocacy coaching. RHIhub on PIN • AAFP on PIN codes

What has to happen first (the “initiating visit”)?

• A physician, NP, PA, CNM, or (for behavioral health) clinical psychologist must conduct an initiating visit to establish medical necessity and a care plan, obtain the patient’s consent, and assign/supervise auxiliary personnel (navigators). RHIhub on PIN

Which codes get billed each month?

• G0023: First 60 minutes of PIN services in a calendar month (auxiliary personnel under practitioner supervision).

• G0024: Each additional 30 minutes in the same month.

• G0140/G0146: Peer‑support versions (first 60 min/each additional 30 min) where applicable.

• Only one practitioner can bill PIN for a patient per month. AAFP on PIN codes • RHIhub on PIN

2025 update for RHCs/FQHCs

Rural Health Clinics and Federally Qualified Health Centers may bill individual PIN codes starting January 1, 2025. RHIhub on PIN

Will I pay anything out of pocket? When is it often $0?

• Original Medicare generally applies Part B cost‑sharing to PIN (e.g., 20% coinsurance after deductible), unless covered by supplemental insurance or other programs. AAFP on PIN codes

• Medicare Advantage (MA) plans set their own copays/coinsurance for PIN‑like care management; many plans set $0 copays for certain care management benefits, but you must check your plan’s EOB/Summary of Benefits. Consumer experiences with MA supplemental benefits vary widely; review details carefully. Medicare Rights Center on MA supplemental benefits • SHIPHelp on MA extras

Scenario	Original Medicare	Medicare Advantage
Has Medigap policy	Medigap typically covers Part B coinsurance, often making PIN $0 at point of service	Plan rules apply; many plans list $0 for care management, but confirm
Dual‑eligible (Medicare + Medicaid)	State Medicaid often covers cost‑sharing, frequently resulting in $0	Plan rules + Medicaid wrap; many members see $0
No Medigap/Medicaid	Standard Part B coinsurance applies	Copay/coinsurance varies by plan; could be $0–$X
Reached MA plan’s MOOP (max out‑of‑pocket)	N/A (Original Medicare has no annual MOOP)	Further in‑network Part A/B cost‑sharing typically $0 for rest of year

Aviator’s public site describes costs as “as low as $0 out‑of‑pocket,” reflecting the scenarios above. Always review your EOB. Aviator (cost language)

How do prior authorizations (PAs) fit in?

PIN itself is a care‑management service. However, your care plan may require tests, referrals, therapies, or durable medical equipment (DME) that do require authorization. Aviator Navigators coordinate PA paperwork with your clinicians and plan, track statuses, and arrange alternatives when denials occur. Aviator services • Aviator mobility help

What happens if something is denied? Can Aviator help with appeals?

Yes. Navigators help you understand denial letters, gather medical necessity support, file plan appeals and grievances, and connect you to unbiased counseling (SHIP/SMP) when marketing or benefit details are unclear—issues that are common with some MA supplemental benefits. Medicare Rights Center on MA experiences • SHIPHelp guidance

What will I see on my EOB/statement?

• The billing provider will appear as the practitioner/organization that performed the initiating visit and supervises navigation (e.g., Aviator Medical Group PA). You may see HCPCS codes G0023/G0024 (and when applicable G0140/G0146) with the allowed amount and any plan‑specific cost‑sharing. AAFP on PIN codes

How is this different from other navigation‑related Medicare services?

In 2024, Medicare also introduced reimbursement for Social Determinants of Health (SDOH) risk assessments and Community Health Integration (CHI). These may be billed in parallel with PIN when requirements are met and time is not double‑counted. Your care team determines which combination best fits your needs. PNCT policy update • AAFP on distinct reporting

Plain‑language definitions

• Prior authorization: Your plan’s pre‑approval for a service or item.

• Coinsurance: The percentage of the Medicare‑allowed amount you pay after deductible.

• MOOP (MA only): The in‑network annual cap on your Part A/B out‑of‑pocket costs.

• EOB: An informational statement from your plan explaining how a claim was processed.

Compliance, privacy, and emergencies

• Your health information is protected; see Aviator’s HIPAA Notice for your rights. HIPAA Notice

• Aviator Medical Group does not provide emergency medical services; call 911 for emergencies. Terms of Use

Quick answers (FAQ)

• Do I need a referral? Your initiating visit with an eligible practitioner is required for PIN. RHIhub on PIN

• Can more than one group bill PIN for me in the same month? No—only one practitioner may bill per patient per month. RHIhub on PIN

• Is messaging with my Navigator limited? Aviator provides regular appointments plus unlimited messaging to support your plan of care. Aviator services

• Will PIN reduce hospital or ER use? Patient navigation and coordinated care have been associated with lower acute utilization in multiple studies; plans support PIN to improve outcomes for complex conditions. AAFP on PIN rationale