Coordinated Specialty Care

CMS recently finalized a HCPCS code for CSC through Medicare’s fee schedule, which we believe will make a big difference in public and private insurer willingness to bill for the full set of services provided in the CSC model. Though some public insurers use various combinations of existing codes that partially identify services within CSC, there has not been a code that fully allows for reimbursement of the full CSC model, notably no codes (and subsequent reimbursement) for non-clinical services such as education and employment support for patients. Private insurance rarely covers such services. CMS has released two HCPCS codes, H2040, which can be billed per month, and H2041, which can be billed per encounter. These two codes allow greater flexibility in the application of various insurance billing policies and greater clarity in claims data. See pages 7-9 of this document for more information.