Wiki S0353 Cancer Tx Plan Initial

[Shelly7169]

I reviewed the NAS Part B Medicare email that was rec'd today. This included HCPCS quarterly update. I am a little confused...There were updates to S codes. Aren't S codes temporary codes for non-Medicare? If so, why would Medicare be sending this update? Has anyone heard anything about codes:

S0353 Cancer Treatment Plan, Initial
Treatment planning and care coordination management for cancer, initial treatment.

S0354 Cancer Treatment Plan, Change
Treatment planning and care coordination management for cancer, established patient with a change in regimen.

This is a big deal if we can start charging for these. I haven't heard anything. Any thoughts? Anyone heard anything?

Thanks, all!
~Shelly

 

[resak]

I believe these went into effect 4/1/12. Some commercial payers, like BCBS, are recognizing and paying for these codes. From everything I've seen, Medicare has no allowable for these services, nor are they on the carrier priced list for my state (Florida).

I agree with you, getting codes for these previously unreimbursed services is a really big deal. It is definately a step in the right direction. Now we just need the payers to recognize and pay for the services we have been rendering.

 

[mitchellde]

HCPC II codes are created by CMS, you were getting the CMS quarterly update to the HCPC II codes via your Medicare provider, s codes are designated non medicare and are used primarily for Medicaid but on a rare occasion are accepted by other carriers.

 

[jayfoxyred]

S0353/s0354

What are the indications for reporting HCPCs codes S0353 or S0354 (BCBS, etc.)? There is a physician fee schedule for these codes from BCBS.
Would you report these for Survivorship care plans or chemotherapy teaching/counseling provided by nurse practitioners?

Thanks!

 

[jbrandt]

S0353

Currently in Ohio the only payer we have using those two S codes are Anthem BC/BS as part of their Quality Care program. They initiated this program maybe a couple of years ago? It boils down to whether or not a patient's on one of their pathways, if they are we're supposed to bill the S codes & be reimbursed for treatment planning, care coordination etc. Most of the time they're paid without incident, every once in awhile they'll deny one & we have to call & explain their own program to them! Good luck!