Summary & Overview
HCPCS S0342: Lifestyle Modification Program for Coronary Artery Disease, Stage 4
HCPCS Level II code S0342 denotes a lifestyle modification program for management of coronary artery disease, specifically the fourth quarter or stage of an established multi-stage intervention. This service code captures comprehensive supportive services—such as counseling, education, and ongoing risk-factor management—delivered as part of a structured secondary prevention program for patients with coronary artery disease. Nationally, recognition of structured lifestyle modification programs is important for reducing recurrent cardiovascular events and coordinating long-term outpatient care.
Key payers considered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what the code represents, payer coverage patterns, common modifier usage, and clinical context relevant to cardiac secondary prevention. The publication also outlines benchmarking and policy-relevant points such as typical sites of service and the role of staged program codes in claims reporting. Data not available in the input is clearly noted where applicable.
Billing Code Overview
HCPCS Level II code S0342 represents a lifestyle modification program for management of coronary artery disease, specifically denoting the fourth quarter / stage of a structured program. The code covers comprehensive supportive services associated with ongoing lifestyle interventions aimed at secondary prevention and risk factor management for patients with coronary artery disease.
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Service type: Lifestyle modification program, including counseling, education, and supportive services focused on cardiovascular risk reduction
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Typical site of service: Outpatient clinic, cardiac rehabilitation program, or community-based preventive care setting
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 62-year-old male with established coronary artery disease (post-percutaneous coronary intervention with stent placement six months prior) attends the fourth-quarter / stage session of a structured lifestyle modification program billed as S0342. The program is delivered by a multidisciplinary outpatient cardiac rehabilitation or disease management clinic and includes individualized counseling on diet, physical activity prescription, tobacco cessation support, medication adherence counseling, psychosocial support, and coordination of supportive services such as nutritionist visits and supervised exercise sessions. Typical workflow: referral from cardiology or primary care, initial intake and risk stratification, delivery of stage-specific education and behavioral interventions across prior quarters, documentation of progress and barriers, adjustment of goals and care plan, and scheduling of follow-up. Services are provided in an outpatient clinic or rehabilitation center; telehealth or hybrid visits may be incorporated when supported by payer policy. Encounter documentation includes the stage of the program (fourth quarter / stage), components delivered, time spent, patient response and goals, communication with referring provider, and any medical necessity justification tied to the patient’s coronary artery disease diagnosis and functional status.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 |