Integrating peer support into Medicare-funded care faces implementation barriers

In the U.S., 21.8% of adults receive behavioral health treatment annually. In 2024, Medicare began allowing physicians to bill Medicare for certified peer-support specialists through the introduction of principal illness navigation peer-support (PIN-PS) reimbursement codes. An interview study with 20 participants, including physicians, certified peer support specialists and leaders, policy professionals, payer representatives, and behavioral health organization leaders, examined barriers and facilitators to PIN-PS adoption. The study found:

• Barriers included limited knowledge of the Medicare navigation codes, skepticism about the impact of peer support, how to integrate support into existing workflows, limited familiarity with billing requirements, and uncertainty about how to schedule and document PIN-PS encounters. 

• Administrative and billing complexity, Medicare cost-sharing requirements, and constraints in reimbursable service time were additional barriers. 

• Facilitators included believing the codes could expand access and reduce inappropriate hospitalizations. 

Why It Matters: These findings may inform ongoing implementation and policy refinement as Medicare-funded peer support continues to develop.

Integrating Peer Support Into Medicare-Funded Care: A Qualitative Study of System-Level Insights From Early Implementation

Corresponding Author: Karen L. Fortuna, PhD, LICSW, et al

The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth,Hanover, New Hampshire

Patient Innovation Lab, Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire 

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