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Christopher Posted Mon 24th of June, 2019 19:41:20 PM
Hello. I was thinking of doing cancer biomarker consultation. It would include an inherited cancer assessment with a geneticist, treatment planning with an oncologist and review of possible clinical trials based on the tumor biomarkers. Could S0353 or S0354 cover this treatment planning if contracted appropriately with the payors or medicare? If not, could you recommend a CPT code or other HCPCS code. Thank you.
SuperCoder Answered Tue 25th of June, 2019 11:04:38 AM


HCPCS code S0353/S0354 are not used for consultation services. These codes are used for planning and care coordination services that facilitate appropriate delivery of health care services to patients with cancer.

HCPCS code S0353/S0354 are not payable by Medicare. S codes represent drugs, services, and supplies that do not possess a permanent national code. However, private sector and Medicaid require these codes to implement policies, programs, or claims processing and meet their particular needs.

Codes 99241-99245 are used for documentation of an office consultation for a new or established patient. But the physician must perform a history, examination with medical decision-making. Usually, the patient presents with a problem or set of problems -- the chief complaint -- which is one of the most important elements of coding appropriately and capturing correct payment.



Christopher Posted Tue 25th of June, 2019 13:19:37 PM
My intention is care coordination. Are these codes used in combination with other CPT codes (99241, etc)? Who might use the s-codes?
SuperCoder Answered Wed 26th of June, 2019 10:17:18 AM



HCPCS S0353 or S0354 are used by some commercial payers under health care plan such as the Cancer Care Quality Program. S codes are used to report drugs, services, and supplies for which there are no national codes but for which codes are needed by the private sector to implement policies, programs, or claims processing. They are for the purpose of meeting the particular needs of the private sector.


Most of the Health Plan considers cancer treatment planning and care coordination a component of overall medical care and management services and, in most instances, not eligible for separate reimbursement. However, separate reimbursement is available to Health Plan participating providers, as approved under a Health Plan program such as the Cancer Care Quality Program. Additional programs may be developed by local Health Plans to support local healthcare initiatives or state mandates.


These codes can be used in combination with other CPT codes as per the payor specific guidelines.



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