Navigating Healthcare's New Horizon: Integrating CMS Codes for Enhanced Patient Care

In the ever-evolving landscape of healthcare, addressing the broader needs of patients goes beyond treating medical conditions—it encompasses understanding and addressing social determinants of health (SDOH) that impact overall well-being.

Recognizing the significance of this, the Centers for Medicare and Medicaid Services (CMS) implemented a set of codes in 2024 aimed at capturing and reporting activities performed by auxiliary personnel and navigators to support SDOH-related needs.

As these proposed codes share similarities with existing Care Management Service codes, the American Society of Clinical Oncology (ASCO) developed a resource to assist physicians, qualified healthcare professionals, and practices in evaluating these new codes and integrating them effectively into current practice activities.


Understanding the New Codes 

The new CMS codes for SDOH-related activities are designed to capture and report the efforts of auxiliary personnel and navigators in addressing social determinants that impact patient health outcomes. These codes aim to provide a structured framework for documenting and reimbursing activities related to addressing SDOH needs within the healthcare system.


Key Points of Comparison

  1. Alignment with Care Management Services

    The new CMS codes share many activities that parallel those of the existing Care Management Service code set family. Both sets of codes focus on coordinating and managing care to optimize patient outcomes, with a particular emphasis on addressing social determinants that impact health.

  2. Scope of Activities

    While Care Management Service codes encompass a broad range of care coordination activities, the new CMS codes specifically target activities related to addressing social determinants of health. This includes activities such as patient education, resource navigation, and coordination of social services.

  3. Integration into Current Practice Activities

    ASCO's resource aims to assist physicians, qualified healthcare professionals, and practices in evaluating how the new CMS codes fit into activities currently being performed. By providing guidance and practical insights, ASCO supports practices in effectively integrating these codes into existing workflows and maximizing reimbursement opportunities.


Practical Guidance for Evaluation and Implementation

  1. Assess Current Practice Activities: Evaluate the activities being performed in your practice related to addressing social determinants of health and care coordination.

  2. Review the New CMS Codes: Familiarize yourself with the new CMS codes and their descriptions to understand how they align with the activities performed in your practice.

  3. Identify Opportunities for Integration: Identify opportunities to integrate the CMS codes into existing practice activities, ensuring alignment with patient needs and practice workflows.

  4. Ensure Accurate Documentation: Ensure that documentation accurately captures the activities performed to support SDOH-related needs, facilitating proper reporting and reimbursement.

  5. Stay Informed: Stay informed about updates and changes related to the CMS codes and continue to evaluate their effectiveness in addressing patient needs and optimizing care delivery.


By understanding and effectively integrating the new CMS codes for social determinants of health into practice activities, oncologists and healthcare professionals can enhance their ability to address the broader needs of patients and improve overall health outcomes. With guidance from resources such as ASCO's, practices can navigate the evolving landscape of oncology care with confidence and compassion. Additionally, innovative platforms like Patient Discovery offer tailored solutions to streamline patient assessments, identify social determinants of health, and facilitate proactive care coordination. By harnessing the capabilities of Patient Discovery, oncologists can seamlessly incorporate the proposed CMS codes into their practice workflows, ensuring accurate documentation and maximizing reimbursement opportunities. Click here to learn more and request a demo.


White Paper: The Business Case for Identifying & Addressing SDoH


Understanding the New CMS Reimbursement Codes: A Guide for Oncologists