2025 HCPCS code S0354
(Deleted) Effective Date: N/A Deletion Date: N/A Miscellaneous Provider Services - Temporary National Codes (Non-Medicare) S0012-S9999 Feed
Treatment planning and care coordination management for cancer, established patient with a change of regimen.
Medical necessity must be clearly documented and should demonstrate why a change in treatment regimen is required for the effective management of the patient's cancer.
The clinician providing the service is responsible for planning and coordinating the patient's cancer care, including evaluating the patient's condition, determining the best course of treatment, and ensuring the proper implementation of the treatment plan.
In simple words: This code covers the doctor's work in planning and managing cancer treatment when a patient's treatment plan needs to be changed. It includes researching the cancer, figuring out the best treatment, estimating how long the treatment will take, and making sure everything goes smoothly.
This code covers the planning for treatment options and care coordination services for an established cancer patient undergoing a change in their treatment regimen. It includes gathering information about the cancer, determining appropriate treatment methods, estimating treatment duration, and coordinating the delivery of care.
Example 1: An established patient with breast cancer who has completed a course of chemotherapy is now starting radiation therapy. The physician uses S0354 to report the planning and coordination of the radiation therapy regimen., A patient with lung cancer whose initial targeted therapy is no longer effective requires a change to immunotherapy. The physician reports S0354 for the development and coordination of the new treatment plan., A patient with leukemia experiences adverse effects from their initial chemotherapy and requires a modified chemotherapy regimen. The physician uses S0354 to bill for the planning and coordination involved in this change.
Documentation should support the medical necessity of the treatment plan change, including the patient's diagnosis, prior treatment, rationale for the change, and the details of the new regimen.
** S0354 was specifically for established patients with a change of regimen, distinct from S0353 used for the initial treatment plan. It was intended to cover the additional work involved in adjusting an existing plan rather than creating a new one.
- Payment Status: Not payable by Medicare
- Specialties:Oncology, Hematology
- Place of Service:Office, Outpatient Hospital, Inpatient Hospital