October 18, 2022

State of Alabama
Press Release: Medicaid

Physician Office Visit Limit Change for Recipients with Active Cancer Treatment

Effective January 1, 2023, Alabama Medicaid will increase the annual physician office visit maximum to 32 
for Medicaid recipients receiving cancer treatment during the calendar year (January - December). This 
increase will be available for each calendar year in which the recipient is receiving cancer treatment and is 
applicable for all cancers.

To qualify for this increase in annual physician office visits,

1. The claim must include one of the following informational procedure codes to identify the treatment stage:

3300F: American Joint Committee on Cancer (AJCC) state documented and reviewed (ONC)
3301F: Cancer stage documented in medical record as metastatic and reviewed (ONC) 
S0353: Treatment planning and care coordination management for cancer initial treatment 
S0354: Treatment planning and care coordination management for cancer established patient with a 
               change in regimen 

(Failure to provide one of the required informational procedure codes will cause the recipient to not be 
eligible for the 32 visits.) 

2. A cancer diagnosis, within the current calendar year, must be in the recipient’s claims history.
Additionally, medical documentation to support the diagnosis and treatment(s) must be maintained in the 
recipient’s record and provided to the Agency, upon request, in the event of audit. 

Providers with billing questions should contact the Gainwell Technologies Provider Assistance Center 
at 1-800-688-7989.

The Current Procedural Terminology (CPT) and Current Dental Terminology (CDT) codes descriptors, and other data are copyright © 2022 American Medical Association and © 2022 American Dental Association (or such other date publication of CPT and CDT). All rights reserved. Applicable FARS/DFARS apply.

  • For more information, visit http://medicaid.alabama.gov
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