Cancer Navigation Improves Equity & Outcomes – Paying for It Matters, Too

By Anabella Aspiras, Assistant Director, Cancer Moonshot Engagement

This year, as part of his Unity Agenda, President Biden set the goal of making navigation services accessible to Americans facing cancer. As First Lady, Dr. Jill Biden has focused on supporting cancer patients and their loved ones, especially by championing the importance of navigation services. Cancer navigation is personalized assistance to patients, caregivers, and families to help identify and resolve barriers to high-quality and timely cancer care through care coordination and advocacy. Navigation can also help address deep-rooted issues of mistrust in the health system related to structural factors that have left some groups behind. The first patient navigation program in America was launched in 1990 by Dr. Harold Freeman in Harlem, New York, as a strategy to improve health outcomes in marginalized communities. The work that Dr. Freeman led decades ago still resonates with urgency today.

Key to this effort have been the Oncology Navigation Standards of Professional Practice, which describe the knowledge and practices that cancer navigators should provide in order to deliver high-quality, competent, and ethical services to people affected by cancer. In health care, if interventions are not standardized and reimbursable through insurance, then even critical services may not be provided, especially in low-resourced settings. Cancer navigation reduces cancer disparities, improves health outcomes, and makes an enormous difference in people’s lives. With First Lady Jill Biden’s leadership, the Biden Cancer Moonshot has taken steps to establish a way for health insurers to pay for navigation services and for health care teams and health systems to provide them – paving a pathway for more support for cancer patients and their families.

Earlier this month, the Centers for Medicare & Medicaid Services (CMS) finalized codes introduced earlier this year for Principal Illness Navigation (PIN) services. These codes describe services focused on removing barriers to care, including care coordination, health education, patient self-advocacy skills, and health system navigation, and facilitating access to community-based social services to address unmet social determinants of health, such as food and housing insecurity and transportation needs. This means that effective January 1, 2024, healthcare providers can use these codes (HCPCS codes G0023 and G0024) for Medicare payment of PIN services. Other payers, outside of Medicare, will be able to pay for these services as well if they elect to do so.

Additionally, the American Medical Association (AMA) issued updated guidance on the appropriate use of CPT codes, which are used by all insurers in reporting clinical navigation services. Clinical navigation focuses on clinical care, coordination, and education, and is typically provided by clinical staff, including nurses and licensed clinical social workers. The AMA codes (CPT codes 99424 – 99427) can be used effective immediately. When the existing CPT codes and the new PIN codes are implemented by health systems and payers, it will drastically expand access to navigation support for people, caregivers, and families facing cancer.

The Biden Cancer Moonshot will continue efforts to expand adoption and payment for navigation services. There is more to be done, because high-quality navigation includes screening support, preventive and pre-diagnosis care. In the meantime, this is a big step forward in delivering on President Biden’s promise—providing patient navigation support to every American facing cancer.

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