Lindsay Conway, Oncology Roundtable
Although more and more cancer programs are offering low dose lung CT screening for high-risk patients, billing remains a challenge. Most payers still do not reimburse for the screening, and even when they do, there are often gray areas.
Below is a list of some of the questions I’ve received from members over the past year about billing for lung cancer screening. How are you managing these challenges? Please add your comments below, or email me at email@example.com.
Lung cancer screening billing and reimbursement challenges
Regina Lohr, Oncology Roundtable
In follow-up to our recent 2013 Oncology Medicare Reimbursement Update, members asked for more specifics on the new Transitional Care Management (TCM) CPT codes included in the 2013 Medicare Physician Fee Schedule.
Requirements, reimbursement vary by patient complexity
The two codes allow providers to bill for one face-to-face visit as well as non-face-to-face services provided to manage patients’ transitions from an inpatient care setting to the community setting (such as the patient’s home or assisted living). Providers billing under these codes must communicate with the patient or caregiver shortly after discharge and meet with the patient within one or two weeks, depending on the complexity of the patient’s case.
What cancer providers need to know about using the new CPT codes
A recent report in the New York Times details Sanofi’s decision to cut the cost of a new cancer drug after physicians at Memorial Sloan-Kettering announced they would not prescribe the drug due to its exorbitant price.
Cancer drug's cost slashed following Sloan-Kettering decision