Summary & Overview
HCPCS S0316: Disease Management Program Follow-Up/Reassessment
HCPCS Level II code S0316 covers follow-up and reassessment services provided as part of a disease management program. This code captures structured encounters intended to monitor clinical status, assess response to interventions, reinforce self-management, and identify needs for care-plan changes. Nationally, disease management follow-up codes matter for care coordination, quality measurement, and payer coverage decisions that affect access to longitudinal chronic disease support.
Key payers addressed in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of what S0316 represents, typical service settings, and which payers commonly cover these services. The publication summarizes available benchmarks and utilization context, highlights relevant policy and coverage considerations that affect national reimbursement and access, and provides clinical context on how follow-up/reassessment services support chronic disease outcomes.
This summary is written for a national audience and focuses on the code’s purpose, payer coverage landscape, and the types of information users can expect to find in the full publication. Data not available in the input is indicated where necessary.
Billing Code Overview
HCPCS Level II code S0316 denotes a disease management program, follow-up/reassessment. The code represents services focused on ongoing monitoring and reassessment of patients enrolled in a disease management program to evaluate treatment progress, adherence, symptom control, and necessary adjustments to the care plan.
Service type: Follow-up and reassessment for disease management programs
Typical site of service: Outpatient clinics, primary care offices, telehealth or case management settings where disease management follow-up is provided
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A patient enrolled in a chronic disease management program presents for a scheduled follow-up and reassessment visit to evaluate response to care plan interventions. Typical patients include adults with one or more chronic conditions such as diabetes mellitus, congestive heart failure, chronic obstructive pulmonary disease, hypertension, or chronic kidney disease. The visit is conducted in an outpatient clinic, primary care office, home health setting, or via telehealth when allowed by payor policy.
A realistic scenario: a 68-year-old patient with type 2 diabetes and stage 3 chronic kidney disease receives a follow-up disease management reassessment six weeks after initial enrollment. The nurse care manager performs medication reconciliation, documents blood glucose logs, reviews home blood pressure readings, assesses adherence and barriers, updates the care plan, and communicates medication changes to the PCP. The clinician documents changes, orders laboratory monitoring as needed, and schedules the next follow-up. Billing uses the HCPCS Level II code S0316 for the disease management program follow-up/reassessment, with an appropriate modifier when required by the payer (for example, telehealth or bilateral service modifiers if applicable). Typical workflow steps include scheduling, pre-visit record review, focused patient assessment, care plan update, documentation, and coordination with the primary provider and other team members.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
GT |