New Medicare Reimbursement Strategy for Patient Navigation Services Will Better Serve Patients with Cancer and Other Serious Illnesses

WASHINGTON, DC – November 2, 2023 – The Centers for Medicare and Medicaid Services (CMS) released their final rule today for the 2024 Medicare Physician Fee Schedule. The rule finalizes a new reimbursement code for patient navigation services focused on patients with serious illnesses like cancer.

“This ruling is a game changer, wherein all boats rise through enhancing access to oncology navigation services. Patient navigation increases understanding of cancer care plans, improves patient outcomes, reduces unnecessary treatment cost, and increases patient satisfaction,” said Dr. Karen E. Knudsen, CEO of the American Cancer Society (ACS) and the American Cancer Society Cancer Action Network (ACS CAN). “The reimbursement strategy within this final rule is a meaningful first step toward expanded and sustainable access to critical services for patients with cancer and other serious illnesses. ACS CAN applauds CMS for recognizing this need and working toward addressing it.”

Successful navigation of health care barriers for patients undergoing cancer treatment involves the deployment of skills and care plans unique to other diseases like heart failure and chronic respiratory disease – making care more manageable for patients by providing additional support through professionally-trained individuals. According to a 2022 survey by ACS CAN, an overwhelming majority of patients and survivors (91%) agree that having access to a patient navigator is very important for cancer patients. However, only 54% of surveyed individuals had encountered a patient navigator.

ACS and ACS CAN have been long-standing advocates of the important role patient navigation services play in surviving cancer.

ACS has funded patient navigators and navigation programs, developed navigation training curricula, and united organizations through the American Cancer Society National Navigation Roundtable.  To help health systems maximize the use of patient navigation across the nation, it is now expanding its work to include a standardized training and credentialing program for professional navigators that will meet the CMS requirements for reimbursement.

Evidence shows that patient navigation helps address health-related social needs and helps reduce disparities in communities of color by providing access to disease prevention education, conducting community outreach and facilitating public education campaigns. In September, ACS CAN issued a letter to CMS, which 59 partners signed on to commenting on the then proposed rule.

“Navigating a confusing and complex health care system after receiving a cancer diagnosis is difficult for anyone. It is incredibly challenging for patients living in communities that have been historically under resourced, who experience numerous barriers to getting the care they need,” added Lisa A. Lacasse, president of ACS CAN. "We look forward to working with CMS to expand access to professionally trained navigators who can help patients overcome barriers to care and improve health outcomes."

The final rule also includes provisions related to improving access to telehealth services and removing health-related social barriers to care.