Forty Cancer Centers Vow to Use Patient Navigation Codes
The White House’s Cancer Moonshot initiative recently announced that 40 comprehensive cancer centers and community oncology practices nationwide have committed to using new navigation codes to provide patient navigation services to people facing cancer.
Seven health insurance companies — Aetna, a CVS Health company; Blue Cross Blue Shield of Minnesota; Elevance Health; Health Alliance Plan; Humana; Priority Health; and Select Health — also announced new commitments to begin paying for navigation services to help patients and their families navigate treatments for cancer and other serious illnesses.
Navigators guide families through every step of their cancer journey, and have been shown to improve health outcomes and the patient experience by reducing times between diagnosis and treatment and by increasing treatment completion. These services also have the potential to lower healthcare costs by reducing ER visits and hospitalizations and reducing health disparities, including by facilitating access to services to address unmet social determinants of health, such as food and housing insecurity and transportation needs.
Nebraska Medicine’s Fred & Pamela Buffett Cancer Center Director Joann Sweasy, Ph.D., said the initiative speaks to the wide-ranging impact of a cancer diagnosis and course of treatment.
“For a family facing a diagnosis or undergoing treatment, sometimes everything can be overwhelming,” Sweasy said in a statement. “These services reduce stress, improve outcomes and help us support patients and their families, so they can face their diagnosis and treatment knowing that we are there to help them in every aspect of their battle. One of our most important messages to our patients is: There is hope. This initiative can help us build that hope for them as we work together for the best possible outcomes.”
In a recent visit to Atrium Health Levine Cancer in North Carolina, first lady of the United States Jill Biden underscored the importance of tackling financial toxicity in cancer care and the critical role of patient navigators in the journey toward recovery. “The patient navigators at Atrium Health Levine Cancer exemplify the kind of support and advocacy we believe is essential for every cancer patient across the country. By addressing everything from transportation to financial barriers, these navigators ensure that patients can focus on what's most important: their health," she said.
One of Atrium Health’s pilot programs addressing financial burdens found that patient anxiety about costs decreased in 33 percent of patients who participated, highlighting the impact of navigators who help with both treatment planning and financial concerns. Atrium Health said it is committed to expanding these services, aiming to improve access to care, especially in rural and regional locations, and supporting at-risk populations.
Until the Cancer Moonshot prioritized increasing these services, Medicare and other health plans largely did not pay for navigation, leaving this service out of reach for many people, especially in low-resourced settings.
The administration announced that Medicare would begin paying for certain navigation services starting Jan. 1, 2024. The Moonshot also led efforts to update existing medical billing codes to enable commercial health insurers to pay for navigation services. The Cancer Moonshot’s efforts to update the billing codes and drive use among providers and insurers means that many patients will be able to access clinical care coordination, health education, patient self-advocacy training, health system navigation and connection to community-based social services to address food and housing insecurity, transportation needs or other issues that could interfere with treatment.
Specifically, the insurers, comprehensive cancer centers and community oncology practices have committed to:
• Provide and cover navigation services using appropriate coding, including CPT codes 99424–99427, and, as applicable, HCPCS codes G0023-G0024, as well as tracking utilization and reimbursement metrics for these codes.
• Capture utilization of navigation codes across patient demographics, including but not limited to geography, race and ethnicity, and sex and gender, where available.
• Track associated health outcomes of patients who are benefitting from navigation services, such as number of emergency room and urgent care visits, available patient-reported outcomes and other care quality and experience measures.
• Support the provision of evidence-based navigation services to patients and caregivers in accordance with the Oncology Navigation Standards of Professional Practice, which describe the knowledge and practices navigators should provide in order to deliver high-quality, competent and ethical services to people affected by cancer.
The 40 comprehensive cancer centers and community oncology practices that have committed to these actions include:
Abramson Cancer Center
AIS Cancer Center | Adventist Health Bakersfield
Atrium Health Wake Forest Baptist Comprehensive Cancer Center
Baptist Health Cancer Care
The Cancer Center at Mercy Hospital Joplin
City of Hope
Dana-Farber Cancer Institute
Duke Cancer Institute
The Fred & Pamela Buffett Cancer Center
Herbert Irving Comprehensive Cancer Center
Huntsman Cancer Institute at the University of Utah
Marian Regional Medical Center | Mission Hope Cancer Center
Masonic Cancer Center, University of Minnesota
Mayo Clinic Comprehensive Cancer Center, Jacksonville, FL
Mayo Clinic Comprehensive Cancer Center, Phoenix and Scottsdale, AZ
Mayo Clinic Comprehensive Cancer Center, Rochester, MN and the Upper Midwest
Mercy Health
Mercy Health System’s Oncology Practices
Mercy Health/Lourdes Hospital Cancer Center
Moores Cancer Center at UC San Diego
Northwell Health
Nuvance Health
Ochsner LSU Health Shreveport
Ohio State University Comprehensive Cancer Center
Penn State Cancer Institute
Sidney Kimmel Cancer Center
St. Elizabeth Healthcare
St. Luke’s Cancer Institute
Sutter Health Memorial Medical Center
UChicago Medicine Comprehensive Cancer Center
University Hospitals Seidman Cancer Center
University of Colorado Cancer Center
University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center
University of New Mexico Comprehensive Cancer Center
UPMC Hillman Cancer Center
USC Norris Comprehensive Cancer Center
UVA Comprehensive Cancer Center
Vail Health Shaw Cancer Center
Wilmot Cancer Institute at University of Rochester
Winthrop P. Rockefeller Cancer Institute
