The Revenue Revolution: How New Medicare Billing is Changing Everything for Peer Specialists

If you're a peer support specialist wondering whether all the buzz about new Medicare billing codes is real—it absolutely is. The Medicare changes that rolled out in 2024 represent the biggest opportunity for career advancement and financial stability that our field has ever seen. Be proactive: Champion this as a new program and revenue stream for your organization.

The bottom line: New Medicare G-codes generate around $80 per hour in revenue compared to the traditional H0038 Medicaid rate of $20-25 per hour. That's 3-4 times more revenue, which means organizations can afford to pay peer specialists significantly more.

The new Medicare G-codes: What they actually mean for you

What are these G-codes anyway? Starting January 1, 2024, Medicare created four new billing codes specifically for something called "Principal Illness Navigation" services. Two of them—G0140 and G0146—are designed specifically for peer support specialists working with people who have serious mental health conditions or substance use disorders.

The money is real. Here’s what makes this a game-changer: instead of billing in 15-minute chunks like we've always done with H0038, these new codes let you bill for a full hour (G0140) and an additional 30 minutes (G0146) per month per client. If you're working full-time and serving six clients a day, you could potentially generate over $100,000 in revenue for your organization through G-code billing. That's compared to generating only $35,000-45,000 in revenue through traditional H0038 billing. Higher revenue generation means organizations can afford to pay peer specialists significantly more.

But there's a catch (of course there is). These aren't just "upgraded" peer support services. Medicare is paying more because they expect more. You need to work under the supervision of a doctor or nurse practitioner, document everything more thoroughly, and your clients have to meet specific criteria for serious conditions that are expected to last at least three months.

The reality of H0038 billing: Where most of us are now

The state-by-state lottery. If you're currently working under H0038 billing (and most of us are), your paycheck depends a lot on which state you live in. South Carolina pays just $5.98 for a 15-minute session, while Ohio pays $36.32 for the same work. Most states cap you at 16 units (4 hours) per day, so your daily earning potential ranges from about $24 to $145 per patient.

Some good news: rates are going up. The good news is that many states finally woke up and started raising rates in 2024. North Carolina put $220 million toward behavioral health rate increases. Virginia bumped rates up 10%. New York kept their 50% group service increases. 48 states plus Washington DC now reimburse for peer support services—that's tremendous progress from where we were just a few years ago.

But Medicare still says "no" to H0038. Here’s the frustrating part: while Medicaid programs across the country pay for H0038 services, Medicare has always marked it as "not payable." That's part of what makes these new G-codes such a big deal—it's the first time Medicare has ever paid for peer support services.

Think of it this way: traditional peer support is like being a skilled craftsperson. G-code peer support is like being a skilled craftsperson who can also read blueprints, work with engineers, and document everything for quality control. It's still the same work, but with additional professional competencies.

What you need to know to level up: Training and skills

The basics haven't changed. The foundation of peer support is still the same: you need your lived experience, typically 1-2 years of recovery, 40-75 hours of initial training (depending on your state), and state certification. SAMHSA's National Model Standards still provide the framework, emphasizing the recovery-oriented, trauma-informed approach we all know.

But G-code work demands more. If you want to access those higher-paying G-code positions, you'll need to level up your skills. This means getting comfortable with medical terminology, learning to work more closely with doctors and nurses, and becoming really good at documentation that proves medical necessity. You're not becoming a clinician, but you are becoming a healthcare team member.

The skills gap is real. Think of it this way: traditional peer support is like being a skilled craftsperson. G-code peer support is like being a skilled craftsperson who can also read blueprints, work with engineers, and document everything for quality control. It's still the same work, but with additional professional competencies.

The salary reality check: Where we are and where we're going

Current pay across the country. Right now, most peer support specialists earn between $30,000 and $46,698 per year nationwide. If you're in Washington state, you're doing better at around $46,462 annually. If you're in the South or rural areas, you're probably making 15-25% less than the national average. Veterans Affairs consistently pays the best, with median salaries around $50,595.

The G-code opportunity could change everything. Here’s where it gets exciting: organizations billing G-codes can generate enough revenue to offer competitive salaries of $60,000-80,000+ per year to experienced peer specialists. That's not hype—that's math based on the reimbursement rates and what organizations can afford when they're generating $100,000+ in revenue per specialist instead of $35,000-45,000. We're talking about potentially doubling your current salary by developing the right skills and finding organizations that do G-code billing.

We're desperately needed. The timing couldn't be better. 160 million Americans live in areas with mental health professional shortages. We need over 8,000 additional peer specialists nationally, and 83% of behavioral health workers say their organizations can't meet current demand. This shortage means more opportunities, better pay, and more respect for what we do.

Why the money makes sense: The research backs us up

We actually work. The research is crystal clear: peer support makes a real difference. Recent studies involving over 4,000 participants show we consistently improve personal recovery outcomes, empowerment, and self-efficacy. When employers invest $100 in mental health benefits that include peer support, they save $190 in reduced healthcare costs and improved productivity.

We save money for everyone. Multiple studies show that good peer support programs actually save money for healthcare systems. We help people stay out of emergency rooms, stick to their medications, and avoid expensive crisis interventions. That's exactly why Medicare decided to create these higher-paying codes—they're not being generous, they're being smart about cost savings.

The evidence justifies the pay. The research supporting higher reimbursement is solid. We're not asking for charity; we're demonstrating value. When peer support programs reduce emergency department visits and improve treatment engagement, the return on investment is clear and measurable.

What this means for you: Practical next steps

If you're working for an organization, talk to your supervisor about these new opportunities. Smart organizations are going to develop programs that use both H0038 for traditional Medicaid clients and G-codes for Medicare-eligible people with qualifying conditions. This isn't about replacing what you do—it's about expanding opportunities. Push for training opportunities that prepare you for G-code work.

If you're just starting out, you're actually in a great position. Instead of having to unlearn old habits, you can train from the beginning with both traditional peer support skills and the enhanced competencies needed for G-code work. Think of yourself as Peer Support 2.0 from day one.

For everyone: The bigger picture. We're at a historic moment. For the first time, Medicare recognizes the value of peer support and is willing to pay professional-level compensation for it.

The organizations and individuals who adapt quickly to these opportunities will lead our field's transformation from a side program to an essential part of healthcare.

The bottom line

The introduction of Medicare G-codes represents the biggest opportunity our field has ever seen. While traditional H0038 billing will continue serving essential Medicaid populations, the 300-400% revenue increase available through G-code billing means organizations can finally afford to offer competitive salaries that reflect the true value of peer support work.

This isn't about becoming something you're not—it's about becoming the best, most professional version of what you already are. The core of peer support—using your lived experience to help others in their recovery—remains exactly the same. What's changing is that organizations can now generate enough revenue to properly compensate peer specialists for the valuable work they've always been doing.

The peer support specialists who invest in developing G-code competencies will have access to positions offering $60,000-80,000+ annually instead of the current $35,000-45,000 range. The opportunity is here. The question is whether you're ready to develop the skills that organizations need to access this higher reimbursement.

Check out our Interactive Project Plan to get a feel for what it takes to create a program from scratch. If you're interested in our complete, detailed business planner developed specifically for peer support programs, DM me or send email to themindfulpeer@gmail.com

Sources

1. Centers for Medicare & Medicaid Services. (2024). Calendar Year (CY) 2024 Medicare Physician Fee Schedule Final Rule. https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2024-medicare-physician-fee-schedule-final-rule

2. American Psychological Association Services. (2024). How to bill for principal illness navigation services. https://www.apaservices.org/practice/reimbursement/health-codes/principal-illness-navigation-services

3. American Academy of Family Physicians. (2024). Coding for PIN Services. https://www.aafp.org/family-physician/practice-and-career/getting-paid/coding/g0023-g0024-g0140-g0146-PIN-codes.html

4. Rural Health Information Hub. (2024). Principal Illness Navigation Services - Care Management Reimbursement. https://www.ruralhealthinfo.org/care-management/principal-illness-navigation-services

5. Commonwealth Fund. (2024). Medicare Reforms Support Behavioral Health by Expanding Access to Peer Support Specialists and Community Health Workers. https://www.commonwealthfund.org/blog/2024/medicare-reforms-support-behavioral-health-expanding-access-peer-support-specialists-and

6. SAMHSA. (2023). SAMHSA's National Model Standards for Peer Support Certification. https://library.samhsa.gov/product/samhsas-national-model-standards-peer-support-certification/pep23-10-01-001

7. North Carolina Department of Health and Human Services. (2023). NC Medicaid Behavioral Health Services Rate Increases. https://medicaid.ncdhhs.gov/blog/2023/11/15/nc-medicaid-behavioral-health-services-rate-increases

8. Virginia Department of Medical Assistance Services. (2024). Behavioral Health Service Rate Updates Effective January 1, 2024. https://vamedicaid.dmas.virginia.gov/bulletin/behavioral-health-service-rate-updates-effective-january-1-2024

9. ZipRecruiter. (2024). What Is Peer Support Specialist Salary by State? https://www.ziprecruiter.com/Salaries/What-Is-the-Average-PEER-Support-Specialist-Salary-by-State

10. Substance Abuse Counselor Organization. (2024). Peer Support Specialist Salary in Substance Abuse. https://substanceabusecounselor.org/substance-abuse-counselor-careers-guide/certified-peer-support-specialist/salary/

11. Council of State Governments. (2024). Mental Health Matters: Addressing Behavioral Health Workforce Shortages. https://www.csg.org/2024/10/10/mental-health-matters-addressing-behavioral-health-workforce-shortages/

12. Commonwealth Fund. (2023). Understanding the U.S. Behavioral Health Workforce Shortage. https://www.commonwealthfund.org/publications/explainer/2023/may/understanding-us-behavioral-health-workforce-shortage

13. BMC Medicine. (2024). The effectiveness, implementation, and experiences of peer support approaches for mental health: a systematic umbrella review. https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-024-03260-y

14. BMC Psychiatry. (2023). The effectiveness of peer support from a person with lived experience of mental health challenges for young people with anxiety and depression: a systematic review. https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-023-04578-2

15. National Institutes of Health. (2024). Return on Investment of Enhanced Behavioral Health Services. https://pmc.ncbi.nlm.nih.gov/articles/PMC11800021/

16. U.S. Department of Health and Human Services ASPE. (2024). An Assessment of Innovative Models of Peer Support Services in Behavioral Health to Reduce Preventable Acute Hospitalization and Readmissions. https://aspe.hhs.gov/reports/assessment-innovative-models-peer-support-services-behavioral-health-reduce-preventable-acute-0

17. Texas Health and Human Services. (2024). Certification for Peer Support as a Medicaid Benefit. https://www.hhs.texas.gov/providers/behavioral-health-services-providers/peer-support-services/certification-peer-support-a-medicaid-benefit

18. National Alliance on Mental Illness. (2024). Workforce: Peer Support Workers. https://www.nami.org/advocacy/policy-priorities/improving-health/workforce-peer-support-workers/

19. Policy Center for Maternal Mental Health. (2024). Gaps in Peer Support Reimbursement and Certification in the United States. https://policycentermmh.org/gaps-in-peer-support-reimbursement-and-certification-in-the-united-states/

20. National Certification Board for Behavioral Health Professionals. (2024). National Certified Peer Specialist (NCPS). https://behavioralhealthprofessional.com/national-certified-peer-specialist-ncps/