Modification to voluntary Cancer Care Quality Program (CCQP) enhanced reimbursement to begin July 1, 2021
Effective July 1, 2021, enhanced reimbursements for medical oncologists selecting on-pathway drug regimens as part of the AIM Oncology/Cancer Care Quality Program chemotherapy authorization process will be adjusted for specific regimens.
Impacted regimens include only select oral and hormonal agents for which a monthly in-office visit may not be required. For these impacted regimens, the optional enhanced reimbursement award, billable using S-codes for treatment planning and care coordination management for cancer, will be reduced from a monthly award during each month of treatment to a single award to accompany treatment initiation (S0353).
This will impact all authorizations submitted through the AIM authorization process on or after July 1, 2021, regardless of planned treatment dates.
AIM/Anthem will continuously review the regimen library to ensure S-code award levels remain consistent with program goals regarding care coordination support.
For a list of the specific regimens that will be impacted by these changes, please review the attached document titled “Single S-code eligible regimens May 2021.pdf”
Contact your Anthem local network consultant or your oncology provider engagement liaison for more information.
May 2021 Anthem Provider News - Georgia