Summary & Overview
HCPCS S0317: Disease Management Program, Per Diem
HCPCS Level II code S0317 denotes a per diem disease management program, a service modality that packages ongoing care coordination, patient education, and monitoring for chronic conditions. Nationally, codes for disease management matter because they capture program-based, time-interval billing that supports population health efforts and chronic care infrastructure across payers.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for program-based billing, how S0317 functions as a per diem code, and what to expect in payer coverage patterns. The publication summarizes benchmarks where available, notes relevant policy and coverage themes for disease management programs, and outlines operational considerations such as typical sites of service and service components.
This report is national in scope and intended for billing managers, revenue cycle staff, and clinical program leads seeking a clear briefing on the role and interpretation of HCPCS Level II code S0317 within disease management service lines.
Billing Code Overview
HCPCS Level II code S0317 represents a disease management program billed on a per diem basis. The service type is disease management involving ongoing care coordination, patient education, and monitoring to manage chronic conditions. The typical site of service for this per diem disease management program is outpatient or clinic-based care where enrolled patients receive regular program services over defined days.
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Clinical & Coding Specifications
Clinical Context
A typical patient enrolled in a disease management program billed with S0317 is an adult with one or more chronic conditions (for example, heart failure, chronic obstructive pulmonary disease, diabetes mellitus, or chronic kidney disease) who requires structured, multidisciplinary care coordination and daily or periodic monitoring. The usual workflow begins with a primary care or specialty physician referral to a disease management vendor or program. An initial comprehensive assessment is completed (medical history, medication reconciliation, recent hospital/ED utilization, psychosocial needs). A per diem disease management service under S0317 covers daily program activities such as telephonic or remote patient monitoring contacts, care coordination between providers, medication adherence counseling, education on self-management, scheduling follow-up appointments, and documentation of care plan updates.
Care is typically delivered by a team including a nurse case manager, care coordinator, pharmacist, and health educator, with oversight by the referring physician. Typical sites of service are outpatient clinic-based disease management programs, home-based remote monitoring programs, or vendor-operated care management centers that provide telephonic and digital outreach. Encounters billed per diem may include multiple brief contacts within the day but are reported once per day to reflect aggregate disease management services rendered that day.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|