Reimbursement for Preventive Counseling Services.

Abstract

The ASCO Cancer Prevention Committee (CAPC) defines cancer prevention as, “a reduction in the risk of developing clinically evident cancer, whether first or second primary cancer, or of developing intraepithelial neoplasia (IEN), a frequent cancer precursor.”1 A recent survey of ASCO members in the United States indicated that despite the significance placed on cancer prevention, the most significant barrier to integration into clinical practice is insufficient reimbursement.2 Therefore, understanding the payment environment for cancer prevention counseling services is a critical step for oncologists to integrate cancer prevention into clinical practice. To provide practical information regarding the types of cancer prevention counseling services that are covered by payers and how these services should be billed, ASCO commissioned Avalere Health, LLC, to conduct a study of Medicare and private payer reimbursement policies. The research focused on prevention scenarios that typically occur during patient encounters, including counseling for smoking cessation, breast cancer or colorectal cancer screening and chemoprevention in high-risk populations, genetics, and the prevention of secondary cancers in cancer survivors.