Health systems are increasingly turning to a workforce that doesn’t require a clinical license: individuals who have experienced a psychiatric disorder — such as post-traumatic stress disorder, depression or substance use disorder — and have been trained to counsel or assist others with that condition.
Peer support specialists, and a growing subset trained specifically in peer recovery support, are being woven into everything from psychiatric emergency units to primary care offices as hospitals and health systems look for ways to engage patients, cut costs and maximize the support for a stretched-thin workforce.
A look at the data
A January brief from the American Hospital Association tied peer support specialists to an average reduction of 43% in inpatient services and a 30% increase in outpatient visits. Other findings cited in the brief add to the financial case: One study found a 56% decrease in readmission rates, another reported an average cost reduction of $2,238 per Medicaid-enrolled month, and a separate analysis calculated a return on investment of $2.28 for every dollar spent.
Reimbursement infrastructure is largely in place, even if underused. Nearly all state Medicaid plans reimburse for peer support specialist services billed in 15-minute intervals, and 34 states now offer a single, integrated peer certification covering both mental health and substance use recovery.
Most certifications require 40 to 46 hours of approved education, and 22 states require supervised work or volunteer hours ranging from 200 to 2,000 hours, with 500 being the most common threshold. Still, as of December 2025, there is no nationally accepted training or certification standard for the role although several organizations have created their own certification programs.
Where the role shows up
Nowhere is the case for peer support specialists more visible than in psychiatric emergency care. Systems are continuously trying to divert patients from crowded emergency departments into settings designed specifically for behavioral health crises.
At Lexington, Ky.-based UK HealthCare, an Emergency Psychiatric Assessment, Treatment and Healing unit — known as EmPATH — that opened in July 2024 has treated more than 10,000 patients in its first two years. The unit employs peer support specialists, a role Marc Woods, DNP, RN, chief nursing officer for the unit, said EDs typically lack. He recalled a patient telling him, “You don’t know what I’ve been through. You can’t help me,” before a peer support specialist stepped in and said, “He can’t, but I can, and I’ve been where you are.”
The unit’s first-year data showed a 63.5% reduction in inpatient admissions and a 92.1% reduction in ED boarding time, gains that Lindsey Jasinski, PhD, the unit’s chief administrative officer, said have held steady into year two.
Other systems are pairing peer roles with similar diversion strategies. In North Carolina, Charlotte-based Novant Health Presbyterian Medical Center partnered with the state’s mobile outreach, response, engagement and stabilization program — MORES. Within an hour, it sends a family peer support specialist alongside clinicians to respond to young people in crisis.
Since the partnership began, behavioral health patients account for fewer than 10% of pediatric ED rooms on a given day, with at least half of those classified as unpreventable social holds, down from 50% to 70% before the program started, according to Courtney Cortes, MSN, RN, Novant’s director of nursing for emergency services.
A specialty within a specialty
As peer support has matured, some systems are drawing a sharper distinction around peer recovery support specialists — peers whose lived experience centers specifically on substance use recovery, embedded upstream of crisis care rather than only inside it.
Edison, N.J.-based Hackensack Meridian Health is among the systems building that role into its primary care strategy.
“We are also expanding our services to include peer recovery specialists and screening in primary care to further assist providers in identifying and addressing issues before they become more acute and require higher and more costly levels of care,” said Kenneth Esser Jr., the system’s executive vice president of behavioral health.
The move is part of a broader “no wrong door” strategy that embeds behavioral health resources, including social workers, directly into primary care settings.
Federal policy
Reimbursement pathways for peer roles have expanded at the federal level, even if uptake remains early. CMS created dedicated billing codes for navigation services effective Jan. 1, 2024, including a principal illness navigation-peer support code, known as PIN-Peer Support — billed under G0140 and G0146. The codes cover care management services delivered by certified peer specialists for patients with serious, high-risk behavioral health conditions.
G0140 covers principal illness navigation peer support provided by certified or trained auxiliary personnel under the direction of a physician or other practitioner, including a certified peer specialist, for 60 minutes per calendar month. G0146 captures each additional 30 minutes of PIN-Peer Support services per patient per month beyond that initial 60 minutes.
Where states haven’t set their own training requirements, auxiliary personnel performing services under G0140 and G0146 must follow the National Model Standards for Peer Support Certification published by the Substance Abuse and Mental Health Services Administration.
In its 2026 final rule, CMS clarified that clinical social workers, marriage and family therapists, and mental health counselors can bill directly for related navigation services tied to a mental illness diagnosis. But adoption of the PIN-Peer Support code remained limited as of the most recent CMS data: Combining facility and office settings, G0140 alone accounted for just 15 rendering providers and 389 total services nationally in 2024.
National health agencies are pushing in the same direction. In a February advisory, the Substance Abuse and Mental Health Services Administration emphasized the role of peer support specialists, alongside community health workers, to expand behavioral health teams into care deserts. The agency argues the roles can improve engagement, satisfaction and recovery outcomes while reducing stigma and the likelihood of recurrence.
The World Health Organization’s global behavioral health investment roadmap similarly calls for scaling training programs for peer support specialists as part of a broader push to reduce reliance on psychiatric hospitals and build out community-based care.
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