HCPCS S0354: Treatment Planning and Care Coordination for Cancer, Change of Regimen

HCPCS Level II code S0354 represents treatment planning and care coordination management for cancer in an established patient undergoing a change of regimen. The code captures non-procedural oncology care activities that support therapeutic decision-making, team communication, and implementation when a patient’s regimen is modified. Nationally, recognition of structured care coordination services is important as oncology treatment becomes more complex and multi-disciplinary.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for use of S0354, common billing considerations, and the types of settings where the service is typically furnished. The publication outlines benchmarks and policy-relevant points for payers and providers, clarifies service line placement for oncology care coordination, and summarizes implications for billing workflows.

This summary serves policymakers, revenue cycle professionals, and clinical leaders seeking a national perspective on how HCPCS Level II code S0354 is used for documenting and billing care coordination tied to changes in cancer treatment regimens. Data not available in the input regarding rates, specific payer edits, and associated taxonomies are omitted.

Billing Code Overview

HCPCS Level II code S0354 denotes treatment planning and care coordination management for cancer for an established patient who has a change of regimen. The service covers interdisciplinary planning, coordination of care between oncology team members, and management activities related to modifying a patient's cancer treatment plan.

Service type: Care coordination and treatment planning for oncology patients
Typical site of service: Outpatient oncology clinics, hospital outpatient departments, and other ambulatory care settings

Clinical Context

A 62-year-old patient with metastatic colorectal cancer established in an oncology practice presents after documented disease progression on first-line chemotherapy. The oncology team reviews recent imaging and laboratory results, documents a discussion of alternative systemic regimens including targeted agents, assesses performance status, reviews comorbidities and supportive care needs, and finalizes a revised treatment plan. The clinical workflow includes: obtaining updated tumor markers and organ function tests; multidisciplinary care coordination with pharmacy for new chemotherapy orders and infusion nursing for schedule adjustments; prior authorization submission to payors (for example, Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, Medicare) if a targeted agent or novel regimen is required; medication reconciliation and counseling; scheduling infusion visits or oral therapy monitoring; and documentation of the change in regimen with medical necessity justification. The service is provided to an established oncology patient when the clinician initiates a change in therapeutic regimen and performs treatment planning and care coordination management documented in the medical record.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when the work, time, or difficulty of treatment planning and coordination is substantially greater than typical for `S0354`. Document rationale and time.

Taxonomy Code	Specialty	Notes
`207Q00000X`	Medical Oncology	Primary specialty providing systemic therapy planning and regimen changes.
`207RA0000X`	Radiation Oncology	Involved if regimen change includes concurrent radiation planning or coordination.
`363L00000X`	Hematology/Oncology	Pediatric or adult hematology-oncology involvement for malignancies with hematologic components.
`174400000X`	Oncology Nursing	Infusion and care coordination nursing involved in scheduling, education, and monitoring.
`208M00000X`	Internal Medicine	Primary care coordination for complex comorbidities impacting regimen selection.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C18.9`	Malignant neoplasm of colon, unspecified	Common primary diagnosis for patients undergoing change in systemic chemotherapy regimen.
`C34.90`	Malignant neoplasm of unspecified part of bronchus or lung, unspecified	Lung cancer patients frequently require regimen adjustments based on progression or molecular testing.
`C50.912`	Malignant neoplasm of unspecified site of right female breast	Breast cancer patients often require treatment planning and coordination when systemic therapy is changed.
`C61`	Malignant neoplasm of prostate	Prostate cancer patients receiving systemic or hormonal therapy may require regimen changes and coordination.
`C25.9`	Malignant neoplasm of pancreas, unspecified	Pancreatic cancer often necessitates complex care coordination when changing chemotherapy regimens due to toxicity and comorbidity.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutes	Commonly used for the face-to-face E/M encounter where treatment planning and regimen change are discussed when E/M is the primary service.
`99354`	Prolonged physician service in the outpatient setting requiring direct patient contact beyond the usual service; first hour	Reported when extended time is spent on treatment planning and care coordination beyond typical E/M visit timeframes and meet prolonged service criteria.
`96365`	Intravenous infusion, for chemotherapy, initial, up to 1 hour	Used when the regimen change results in administration of a new intravenous chemotherapy agent during the visit.
`96413`	Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or first agent	Used for administration of chemotherapy related to the new regimen selected during planning.
`99499`	Unlisted evaluation and management service	May be used rarely for highly atypical care coordination services that do not map to other CPT codes.

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Summary & Overview