According to Empire BCBS NY: in order to align the program intention to support member care coordination and to ensure compliance with regulatory requirements surrounding the program, Empire BCBS is amending the approach for enhanced reimbursement that accompanies selection of ‘on-pathway’ chemotherapy drug regimens as part of the AIM Oncology/Cancer Care Quality Program.
Starting 07/01/2021, authorization process for on-pathway drug regimens as part of the AIM Oncology/Cancer Care Quality Program chemotherapy, will be adjusted to reflect specific regiments and enhanced reimbursements, for the medical oncologists.
Which regiments are affected?
Only select oral and hormonal agents for which a monthly in-office visit may not be required.
Which Authorizations will be affected?
This will impact all authorizations submitted through the AIM authorization process on or after July 1, 2021, regardless of planned treatment dates.
Which HCPCS codes will be affected?
Billable S-codes for treatment planning and care coordination management for cancer.
How will be the payment affected for the billable S-codes?
The optional enhanced reimbursement award will be reduced from a monthly award during each month of treatment to a single award to accompany treatment initiation (S0353)
AIM/Empire will continuously review the regimen library to ensure S-code award levels remain consistent with program goals regarding care coordination support.
If you have any questions, please Contact your Empire network representative or your oncology provider engagement liaison for more information.
Click here for the full updated Cancer Treatment Planning and Care Coordination policy (Commercial Plans)