Last week, the Centers for Medicare & Medicaid Services (CMS) released the new G-codes established for the 2006 Oncology Demonstration Program.ASCO has developed an easy-to-read listing of the codes.The complete 2006 HCPCS coding update as posted by CMS is also available on the ASCO website.

To qualify for the additional $23 demonstration payment, hematologists/oncologists must report one G-code from each of the following three sections in conjunction with a level 2, 3, 4, or 5 established patient office visit:

1. Primary focus of visit (select from 6 codes)
2. Practice guideline adherence (select from 7 codes)
3. Current disease state (select from 68 codes)

The 2006 demonstration program focuses on the physician’s evaluation and management service; therefore, there is no longer a requirement that the patient encounter be related to chemotherapy to qualify for the demonstration payment.CMS has developed a fact sheet with more information about the demonstration, and we anticipate that CMS will provide additional guidance on billing and documentation in the upcoming weeks.In addition, ASCO has asked CMS to clarify several of the published G-codes for current disease state that may be potential sources of confusion (for example, two pairs of codes in the non-Hodgkin’s lymphoma section have almost identical descriptors).

ASCO is also developing tools to help make the clinical practice guidelines that are relevant to the demonstration more easily accessible to members and will provide updates when these resources are available.