A New Era for Oncology Patient Navigation

On November 2, 2023, the Centers for Medicare & Medicaid Services released the Medicare physician fee schedule final rule for calendar year 2024 that retains the principal navigation services code, community health integration services code, and social determinants of health risk assessments.¹ These initiatives advance the goals of the Cancer Moonshot, and the one most central to the Academy of Oncology Nurse & Patient Navigators is the coding and payment for principal illness navigation services. It is an important first step in fulfilling the Cancer Moonshot goal of making navigation services available for every American with cancer. It is critical in the Moonshot drive for health equity because patient navigation is an evidence-based practice that addresses equity of care in individual communities to help underserved populations, including addressing unmet health-related social needs that can potentially interfere with diagnosis and treatment.² And as of January 1, 2024, it is a start to receive payment for navigation services around the treatment of cancer.

The Cancer Moonshot worked with the American Medical Association to clarify usage of existing codes for navigation services. On November 15, 2023, the Current Procedural Terminology (CPT) codes were released recognizing clinical and patent navigators.³ The Oncology Navigation Standards of Professional Practice, which describe the knowledge and practices that cancer navigators should provide to deliver high-quality, competent, and ethical services to people affected by cancer, were recognized as a key tool.⁴ The navigators will work under the supervision of a physician or other qualified healthcare professional, and patients must give consent for the navigation services.

It is a critical step in the Funding Stability domain within the Patient Navigation Sustainability Assessment Tool.⁵ Conversations and advocacy continue for private insurers as well as state (Medicaid) to pay for navigation services.

It is a fantastic way to start 2024 as organizations learn how to apply the CPT codes on behalf of navigators for patient-centered care!

References

1. US Department of Health and Human Services. CMS Finalizes Physician Payment Rule that Advances Health Equity. www.hhs.gov/about/news/2023/11/02/cms-finalizes-physician-payment-rule-advances-health-equity.html
2. Academy of Oncology Nurse & Patient Navigators. Navigation Is a Critical Component in a Comprehensive Approach to Dismantling Health Inequities. www.aonnonline.org/images/AONN/PR/2023-07-25_AONN_LC_Health_Inequities_Statement_FINAL.pdf
3. CPT Assistant. Reporting CPT Codes for Oncology Navigation Services: The Cancer Moonshot. www.ama-assn.org/system/files/cpt-assistant-oncology-navigation-codes.pdf
4. Franklin E, Burke MA, Dean M, et al. Oncology Navigation Standards of Professional Practice. www.jons-online.com/issues/2022/march-2022-vol-13-no-3/4399-oncology-navigation-standards-of-professional-practice
5. University of Colorado. The Colorado Cancer Screening Program (CCSP). https://sustaintool.org/psat/case-study/the-colorado-cancer-screening-program-ccsp/