The initiative to combat cancer, spearheaded by the current administration, known as the Cancer Moonshot, stands to significantly impact virtual cancer care companies. This initiative, which was initially launched by President Barack Obama in 2016, has been given renewed focus under President Biden in 2022, with the goal of halving cancer mortality rates over the next quarter-century. Additionally, the initiative targets the enhancement of payment mechanisms for cancer navigation services, which has emerged as a pivotal area for innovation among digital health startups.
The Cancer Moonshot’s objectives are twofold: a long-term reduction in cancer death rates and the immediate expansion of cancer care navigation services. In a notable development towards achieving these objectives, the American Medical Association announced in November that it had collaborated with the moonshot team to introduce new CPT codes. These codes are designed to provide reimbursement for clinicians and community health workers who deliver cancer navigation services, which facilitate patients’ management of appointments, medications, and the myriad challenges that accompany a cancer diagnosis. Historically, these essential services have been offered without specific reimbursement mechanisms, often for decades.
The introduction of these procedural codes is a watershed moment in a year marked by uncertainty regarding digital health reimbursement. Companies specializing in cancer care navigation view these codes as vital for increasing the adoption of their services and securing financial stability. Moreover, the establishment of these codes is likely to attract new entrants to the field, increasing competition and potentially improving service quality.
The newly introduced CPT codes encompass reimbursement for clinical coordination services, which require a licensed practitioner, and patient navigation services, which can be performed by professionals such as community health workers. The latter are particularly focused on addressing social determinants of health, aiming to improve overall patient welfare.
Further bolstering this initiative, CMS rolled out two healthcare common procedure coding system codes on January 1. These codes enable providers to be reimbursed for offering principal illness navigation services, including care coordination, health education, enhancing patient self-advocacy skills, and facilitating access to community-based social services. Together, these codes ensure providers can receive Medicare reimbursement for delivering comprehensive care navigation services.
In summary, the Cancer Moonshot initiative under President Biden is catalyzing significant advancements in virtual cancer care, particularly in the realm of cancer navigation services. The introduction of reimbursement codes is a critical step forward, offering opportunities to both providers and digital health companies, the latter of which we predict will proliferate as the Cancer Moonshot program rolls out.
Frier Levitt is highly experienced in representing oncology practices and start-up digital health companies, and has attorneys experienced in CMS reimbursement requirements. Please let us know if we can be of assistance.
