Quantifying the groundbreaking shift in the 2024 CMS physician fee schedule
Oncology practices can now be reimbursed for work that addresses SDoH for their patients
Oncology providers have long understood the impact of social determinants of health (SDoH) on patient outcomes.
There is overwhelming agreement that more needs to be done to support patients.
Most practices stretch limited resources and budgets to help meet patient needs, but historically few have been reimbursed for these activities due to the difficulty of operationalizing the CMS codes.
Oncology providers have been clear that to help patients more effectively and efficiently, they need more financial support and practical solutions for delivering patient support at scale.
With this change from CMS, practices now have the capacity to not only support more patients but also improve the financial health of the practice
CMS has responded to the financial challenges with a series of new codes designed to enable the sustainable delivery of holistic, patient-centered care by reimbursing for the activities of both clinical and non-clinical staff supporting patients.
This historic shift has created an unprecedented opportunity for providers to not only enhance care quality but also the financial and operational health of their practices. When support is delivered at scale, the reimbursement opportunity for providers grows to as much as $232,000 per physician, per year.
About the new codes
CMS understands that addressing the non-clinical needs of patients requires investment in people and technology resources. The 2024 Physician Fee Schedule expands reimbursement to investments made in standardized SDoH risk assessment tools and services delivered by the broader care team, including non-clinical staff.
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Prioritizes the need to identify social needs that may influence care or treatment decisions.
CPT Code G0136
5-15 minutes every 6 months -
Supports resolution of social needs by reimbursing for actions taken by non-clinical staff including community health workers as they educate patients, build self-advocacy, and address identified needs.
CPT Code G0019
60 minutes per monthCPT Codes G0019 + G0022
For each additional 30 minutes per month -
Focuses on ensuring access for patients as they navigate the healthcare system, including patients without social needs. Works in parallel to CHI and reimburses non-clinical staff who support activities like care coordination, health education, patient advocacy, and referrals.
CPT Code G0023
60 minutes per monthCPT Codes G0023 + G0024
For each additional 30 minutes per month
How Patient Discovery can help
A low-cost, easy-to-integrate solution, Patient Discovery is a standardized digital tool that maximizes care team resources to deliver patient support at scale.
Seamlessly accessed from the clinical workflow, Patient Discovery:
Proactively engages patients to communicate what matters most for their treatment and care plan
Administers a comprehensive SDoH risk assessment to efficiently identify unmet needs impacting patient diagnosis and treatment
Intelligently automates referrals to patient support resources, allowing social workers and navigators the time they need to provide help where it’s needed most
Captures the activities of the expanded care team to meet payer reimbursement requirements
Quantify the value for your practice
In partnership with Cencora (formerly AmerisourceBergen), Patient Discovery is scheduling value assessments designed to help oncology practices calculate the reimbursement opportunities associated with these new codes.
Ready to get your value assessment? Get in touch today:
1. AmerisourceBergen Community Oncology Social Determinants of Health Survey, February 20232. Net approximate value based on complex patient needs and multiple supporting clinicians per patient encounter