Medicare and Medicaid Initiates Payment for Patient Navigation, Boosting Cancer Care Equity

Medicare will begin reimbursing for patient navigation services starting January 1, a move aimed at improving cancer care outcomes and potentially reducing health disparities. The Centers for Medicare and Medicaid Services (CMS) has created four new CPT codes that allow healthcare providers to bill for guiding patients through complex treatment involving multiple specialties.

 

Patient navigation, which originated in Harlem in the 1960s to address disparities in cancer care, has shown to improve outcomes for both rich and poor patients while lowering overall care costs. The American Cancer Society (ACS) played a key role in advocating for this change and has developed a standardized training and credentialing program called Leadership in Oncology Navigation (LION) to meet CMS requirements.

 

“This is one of the biggest celebrations we’ll possibly have in my time at the American Cancer Society. This truly is a major step forward toward improving outcomes from cancer,” said Karen Knudsen, CEO of ACS.

 

The new rule allows for reimbursement of lay navigators, with ACS hoping to expand coverage to clinical navigators in the future. Patient navigation has been shown to be particularly effective in increasing clinical trial enrollment and addressing health disparities in cancer care.

 

Robert Winn, director of VCU Massey Cancer Center, noted, “This is the proof of principle that when you help the poorest of the poor you address systemic problems—including those that afflict the rich.”

 

ACS’s credentialing program aims to ensure high-quality navigation services and standardize the growing field. The organization sees this as a crucial step in improving cancer care access and outcomes for all patients.