2025 HCPCS code S0353
(Invalid) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Miscellaneous - Miscellaneous Provider Services S0199-S0400 Temporary National Codes (Non-Medicare) S0012-S9999 Feed
Treatment planning and care coordination management for cancer, initial treatment.
Medical necessity must be clearly documented.The treatment plan and care coordination services must be reasonable and necessary for the management of the patient's cancer. As this code is not payable by Medicare, payer-specific policies should be verified.
Report this code for the planning and care coordination services that facilitate appropriate delivery of health care services to patients with cancer.Use this code for a new patient when the provider initiates the treatment.Terminology: New patient: A patient who has never seen a specific provider or another provider in the same group practice billing under the same group number or who has not seen the provider within the past 36 months.
In simple words: This code covers the initial planning and coordination of cancer treatment.It includes creating a treatment plan, gathering information about the cancer, deciding on treatment methods, and estimating the treatment timeline. It also includes making sure the treatment plan is followed correctly.
This code covers the planning for treatment options and care coordination services for a patient with cancer. It is used for the initial treatment of the patient.It includes planning of a treatment regimen that involves gathering of information about the cancer, methods to treat the patient’s condition, and estimation of time to manage the patient. Care coordination service monitors the accurate delivery of the treatment plan to the patient.
Example 1: A new patient is diagnosed with breast cancer and the oncologist develops a treatment plan including surgery, chemotherapy, and radiation therapy.S0353 is reported for the initial treatment planning and care coordination., A patient with leukemia sees an oncologist for the first time. The oncologist creates a treatment plan involving targeted therapy. S0353 is reported for the initial planning and coordination of care., A patient with lung cancer consults with a radiation oncologist for the first time to discuss a course of radiation therapy. The radiation oncologist develops a treatment plan and coordinates the patient's care. S0353 is reported for the initial planning and care coordination.
Documentation should support the medical necessity of the treatment plan and care coordination services, including the diagnosis, treatment plan details, and the provider's involvement in coordinating the patient's care.As of December 31, 2022, this code is no longer eligible for reimbursement by Anthem.
** This code was historically billable by some payers but is now considered a component of Evaluation and Management (E/M) services and is not separately reimbursed by many payers including Medicare and Anthem.Always verify payer-specific guidelines before billing this code. As of today, December 1st, 2024, the information provided is current and may be subject to change based on future updates to the HCPCS code set.Refer to iFrameAI for the most up-to-date information.
- Payment Status: Not payable by Medicare
- Specialties:Oncology, Radiation Oncology, Hematology
- Place of Service:Office, Outpatient Hospital