{"id":183374,"date":"2026-08-18T13:18:25","date_gmt":"2026-08-18T13:18:25","guid":{"rendered":"https:\/\/pabau.com\/?p=183374"},"modified":"2026-08-18T13:39:32","modified_gmt":"2026-08-18T13:39:32","slug":"hcpcs-code-s0316","status":"publish","type":"post","link":"https:\/\/pabau.com\/fr\/procedure-codes\/hcpcs-code-s0316\/","title":{"rendered":"HCPCS code S0316: Disease management program follow-up\/reassessment"},"content":{"rendered":"\n<script type=\"application\/ld+json\">{\"@context\":\"https:\/\/schema.org\",\"@type\":\"MedicalWebPage\",\"headline\":\"HCPCS code S0316: Disease management program follow-up\/reassessment\",\"description\":\"HCPCS code S0316 (disease management program, follow-up\/reassessment) billing guide for 2026. Covers payer coverage, fee schedules, modifiers, related codes S0315 and S0317, and documentation requirements.\",\"url\":\"https:\/\/pabau.com\/procedure-codes\/hcpcs-code-s0316\/\",\"audience\":{\"@type\":\"MedicalAudience\",\"audienceType\":\"Clinician\"},\"reviewedBy\":{\"@type\":\"Person\",\"name\":\"Dr Vanja Kitanova\",\"jobTitle\":\"Medical Reviewer\",\"affiliation\":{\"@type\":\"Organization\",\"name\":\"Pabau\"},\"knowsAbout\":[\"Medical Coding\",\"Clinical Documentation\",\"Healthcare Billing\",\"Clinical Safety\"],\"sameAs\":\"https:\/\/pabau.com\/blog\/author\/vanja\/\"},\"datePublished\":\"2026-07-01\",\"dateModified\":\"2026-08-18\"}<\/script>\n\n\n        <div id=\"key_takeaways\">\n            <div class=\"header\">\n                                    <img decoding=\"async\" src=\"https:\/\/pabau.com\/wp-content\/uploads\/2025\/12\/Key-Takeaways-Icon.svg\" alt=\"Key takeaways\" height=\"42\" width=\"42\">\n                                <h3>Key takeaways<\/h3>\n            <\/div>\n            <div class=\"list\">\n                                                            <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>HCPCS code S0316 covers follow-up and reassessment visits inside an established disease management program.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>Traditional Medicare does not pay S0316, but many Medicaid managed care plans and commercial payers do.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>S0315 covers the initial enrollment assessment, and S0316 covers every reassessment visit that follows it.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>S0317 is a per diem code, so it bills by day of program participation rather than by visit.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>Practice management software like Pabau tracks S0316 claims, applies the right modifiers, and keeps documentation audit-ready.<\/p>\n                        <\/div>\n                                                <\/div>\n        <\/div>\n    \n\n\n<p class=\"wp-block-paragraph\">HCPCS code S0316 is the billing code for disease management program follow-up and reassessment services. Report it when a patient already enrolled in a structured program attends a visit to review progress, adjust goals, or reassess their care plan.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">It belongs to <a href=\"https:\/\/www.cms.gov\/medicare\/coding-billing\/healthcare-common-procedure-system\" target=\"_blank\" rel=\"nofollow noopener\">HCPCS Level II<\/a>, the code system maintained by the Centers for Medicare and Medicaid Services (CMS). Level II covers supplies, services, and procedures that CPT codes do not capture. Within it, S0316 sits in the S-code range, which Medicaid managed care plans and commercial insurers use most.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">For practices running chronic disease programs, the difference between S0316 and the codes either side of it decides whether a claim gets paid. <a href=\"https:\/\/pabau.com\/blog\/practice-management-software\/\">Practice management software<\/a> can carry the code through to the claim, but somebody still has to pick it correctly.<\/p>\n\n\n\n<h2 id=\"h-s0316-code-details-at-a-glance\" class=\"wp-block-heading\">S0316 code details at a glance<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The table below summarizes the core code attributes for S0316 under the 2026 HCPCS update cycle. S-codes are reviewed every year, so check the <a href=\"https:\/\/www.cms.gov\/medicare\/coding-billing\/healthcare-common-procedure-system\/quarterly-update\" target=\"_blank\" rel=\"nofollow noopener\">CMS HCPCS update<\/a> before you submit.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Attribute<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Detail<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">HCPCS code<\/td>\n<td style=\"padding:12px 16px;color:#374151\">S0316<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Short description<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Disease management program, follow-up\/reassessment<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Long description<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Disease management program, follow-up\/reassessment<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Code type<\/td>\n<td style=\"padding:12px 16px;color:#374151\">HCPCS Level II<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Category<\/td>\n<td style=\"padding:12px 16px;color:#374151\">S-codes (temporary national codes)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Section<\/td>\n<td style=\"padding:12px 16px;color:#374151\">S0000&ndash;S9999 temporary national codes (non-Medicare)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Medicare coverage<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Typically not covered<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Primary payers<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Medicaid managed care plans; commercial and private insurers<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">2026 status<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Active (verify with the CMS 2026 HCPCS release)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<h2 id=\"h-what-services-does-s0316-cover\" class=\"wp-block-heading\">What services does S0316 cover?<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">S0316 covers follow-up and reassessment visits inside an established disease management program. Onboarding appointments do not qualify. The code applies to the ongoing structured encounters where a clinician reviews progress against program goals, adjusts the care plan, and documents the reassessment.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Payers contract disease management programs for diabetes, heart failure, asthma, COPD, hypertension, and similar chronic conditions. Practices running those programs on <a href=\"https:\/\/pabau.com\/industry\/functional-medicine-software\/\">functional medicine software<\/a> can see enrollment status and visit cadence on the record. That context stops a follow-up being coded as an initial assessment.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Services typically documented under S0316 include:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Review of patient-reported symptoms and self-management data since the last program visit<\/li>\n\n\n\n<li>Reassessment of clinical goals, such as HbA1c targets, blood pressure control, or peak flow readings<\/li>\n\n\n\n<li>Medication adherence review and any care plan adjustments that follow from it<\/li>\n\n\n\n<li>Patient education reinforcement specific to the enrolled disease management program<\/li>\n\n\n\n<li>Coordination with the patient&rsquo;s primary care or specialist team as part of program protocols<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">S0316 is not meant for evaluation and management (E\/M) services billed under CPT. If the visit rises to a billable E\/M encounter, check payer policy on whether the CPT code applies instead. Structured <a href=\"https:\/\/pabau.com\/blog\/patient-care-management\/\">patient care management<\/a> makes that call easier, because the note already shows what the visit contained.<\/p>\n\n\n\n<h2 id=\"h-s0315-vs-s0316-initial-assessment-vs-follow-up\" class=\"wp-block-heading\">S0315 vs S0316: Initial assessment vs follow-up<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The S0315 and S0316 mix-up is one of the most common coding errors in disease management billing. Both codes sit in the same series, but they describe different points in the patient&rsquo;s program journey. Billing S0316 for an enrollment visit, or S0315 for a reassessment, usually ends in a denial or a documentation request.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Code<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Description<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">When to use<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Program status<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">S0315<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Disease management program; initial assessment and initiation of program<\/td>\n<td style=\"padding:12px 16px;color:#374151\">First encounter when the patient is enrolled in the program<\/td>\n<td style=\"padding:12px 16px;color:#374151\">New enrollee; baseline assessment<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">S0316<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Disease management program, follow-up\/reassessment<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Every subsequent visit to review progress and adjust the care plan<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Existing enrollee; ongoing program participation<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">S0317<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Disease management program; per diem<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Per-day billing for program participation, where the payer contracts it that way<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Existing enrollee; billed by day rather than by visit<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Key rule:<\/strong> bill S0315 once per program enrollment event. Bill S0316 for every follow-up and reassessment visit after that. S0317 works on a different basis again, because it is a per diem code rather than a per-visit one. Confirm with each payer contract whether a per diem arrangement applies before you use it.<\/p>\n\n\n\n<h2 id=\"h-payer-coverage-does-medicare-cover-hcpcs-code-s0316\" class=\"wp-block-heading\">Payer coverage: Does Medicare cover HCPCS code S0316?<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Traditional Medicare fee-for-service does not cover S0316. S-codes are temporary non-Medicare codes, and as a category they sit outside the Medicare Physician Fee Schedule. Practices billing Medicare should not expect S0316 to process. Checking your Medicare Administrative Contractor (MAC) for local policy is still worth a few minutes.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Practices contracted with Medicaid managed care or commercial payers will find S0316 broadly supported, though coverage is not universal. <a href=\"https:\/\/pabau.com\/blog\/primary-care-software\/\">Primary care software<\/a> that stores each plan&rsquo;s rules alongside the patient record saves the billing team a lookup on every claim. The payer landscape breaks down as follows:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Medicaid managed care plans:<\/strong> Many state managed care organizations (MCOs) accept S0316 under contracted disease management programs. Coverage varies significantly by state, so verify with the specific MCO before billing.<\/li>\n\n\n\n<li><strong>Commercial and private insurers:<\/strong> Many commercial payers that contract disease management programs accept S0316. Contract terms govern whether the code is covered and at what rate.<\/li>\n\n\n\n<li><strong>Medicare fee-for-service:<\/strong> Typically not covered, because S-codes sit outside the Medicare Physician Fee Schedule. Check with your MAC if you believe a coverage exception applies.<\/li>\n\n\n\n<li><strong>Medicare Advantage plans:<\/strong> Some Part C plans accept S-codes under their supplemental benefit coverage. Verify directly with the plan before billing.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Medicaid coverage of S0316 varies by state and by managed care plan, so billing staff should confirm policy rather than assume it. Run <a href=\"https:\/\/pabau.com\/blog\/insurance-eligibility-verification\/\">eligibility verification<\/a> against the patient&rsquo;s plan and pull that plan&rsquo;s own fee schedule before submitting.<\/p>\n\n\n        <div id=\"pro_tip\">\n            <div class=\"img\">\n                <svg width=\"42\" height=\"42\" viewBox=\"0 0 42 42\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M12.6383 19.5238C12.6632 21.2071 12.8734 22.9926 12.0685 24.5523C11.0341 26.8917 8.45076 28.169 7.56292 30.5918C6.63082 33.1061 7.19505 36.185 9.31371 37.9786C10.929 39.5678 13.4183 39.9873 15.6061 39.5463C17.4592 39.073 19.1049 37.8388 19.9706 36.1608C20.781 34.7141 20.7866 32.9904 20.5293 31.3985C20.1006 29.3092 18.3775 27.8705 16.9807 26.362C14.8814 24.1005 14.6684 20.6854 15.595 17.8915C16.4331 15.4768 19.0026 14.2344 20.0425 11.9461C20.7202 10.6769 20.7506 9.20327 20.6068 7.81304C20.1864 5.40098 18.3139 3.23631 15.8716 2.56674C13.9742 2.03969 11.8224 2.30052 10.1739 3.37614C8.70522 4.34688 7.5878 5.86618 7.28356 7.58178C6.76081 9.82981 7.53525 12.2822 9.20307 13.9118C10.7658 15.4741 12.4806 17.2273 12.6383 19.5238Z\"\n                        fill=\"#2BADD4\" \/>\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M22.7048 19.8387C22.6822 22.3279 24.4507 24.6234 26.7493 25.4682C28.0531 25.961 29.4725 25.9183 30.7989 25.5487C32.0575 24.9955 33.301 24.2237 34.0069 23.0092C34.8384 21.5811 35.2982 19.8286 34.7832 18.2094C34.3611 16.2507 32.8739 14.6541 31.0275 13.9426C28.6736 12.9595 25.8073 13.7942 24.1719 15.7001C23.2022 16.8366 22.6143 18.3326 22.7048 19.8387Z\"\n                        fill=\"#2BADD4\" \/>\n                <\/svg>\n            <\/div>\n            <div class=\"text\">\n                <h3>Pro Tip<\/h3>\n                <p>Run a payer eligibility check before every disease management visit. Confirm that S0316 is covered under the patient&rsquo;s plan and that their program enrollment is still active. One missed check can trigger denials across every follow-up claim you file after it.<\/p>\n            <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-s0316-fee-schedule-and-reimbursement-rates-2026\" class=\"wp-block-heading\">S0316 fee schedule and reimbursement rates (2026)<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Individual payers set the reimbursement rate for S0316, not CMS. S-codes carry no published national payment rate, unlike CPT codes on the Medicare Physician Fee Schedule. What you collect depends on the rate you contracted with each Medicaid MCO or commercial payer.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Sound <a href=\"https:\/\/pabau.com\/blog\/what-is-revenue-cycle-management\/\">revenue cycle management<\/a> means requesting the S0316 fee schedule from every contracted payer during negotiation and reviewing it each year. Rates differ substantially between plans and regions. The table below shows the factors that move the number:<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Rate factor<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Notes<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Payer type<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Medicaid MCO, commercial, or Medicare Advantage plan dictates the applicable fee schedule<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">State and geography<\/td>\n<td style=\"padding:12px 16px;color:#374151\">State Medicaid rates and regional commercial plan rates vary significantly<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Facility vs non-facility<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Some payers pay differently for a facility setting than for an office or home-based one<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Contracted program type<\/td>\n<td style=\"padding:12px 16px;color:#374151\">The rate can depend on which disease-specific program the payer has contracted<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Medicare fee schedule<\/td>\n<td style=\"padding:12px 16px;color:#374151\">No published national rate, because S0316 is not on the CMS Physician Fee Schedule<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Third-party lookup tools will show you ranges, but the only number that governs your payment is the one in your contract. Reconcile every S0316 rate against your own signed fee schedule.<\/p>\n\n\n\n<h2 id=\"h-how-to-bill-hcpcs-code-s0316\" class=\"wp-block-heading\">How to bill HCPCS code S0316<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Getting S0316 claims paid consistently takes the right documentation, correct modifier use, and a clear picture of which payers accept the code. Use the steps below as a baseline, then layer your own payers&rsquo; billing guidelines on top.<\/p>\n\n\n\n<ol class=\"wp-block-list\">\n<li><strong>Confirm program enrollment and payer coverage.<\/strong> Check that the patient is actively enrolled in a qualifying disease management program and that their plan covers S0316. Run eligibility and benefits before the visit.<\/li>\n\n\n\n<li><strong>Establish that this is a follow-up, not an initial assessment.<\/strong> S0316 applies only to encounters after the initial program assessment. If this is the patient&rsquo;s first program visit, S0315 is the right code.<\/li>\n\n\n\n<li><strong>Document the reassessment content.<\/strong> The note must show a genuine reassessment: progress against goals, symptom review, adherence data, and any care plan adjustments. Thin documentation is a common denial trigger.<\/li>\n\n\n\n<li><strong>Apply applicable modifiers.<\/strong> Review the modifier table below and append any modifier your payer requires or permits for the circumstances of the service.<\/li>\n\n\n\n<li><strong>Submit on the correct claim form.<\/strong> S0316 goes on a CMS-1500 professional claim, or its electronic equivalent, the <a href=\"https:\/\/pabau.com\/blog\/837-file\/\">837 file<\/a>. Confirm the place of service code matches where the service happened.<\/li>\n\n\n\n<li><strong>Track and reconcile.<\/strong> Watch the <a href=\"https:\/\/pabau.com\/blog\/electronic-remittance-advice\/\">electronic remittance advice<\/a> for every S0316 claim. A denial citing a non-covered service usually points at a coverage problem rather than a coding one.<\/li>\n<\/ol>\n\n\n\n<p class=\"wp-block-paragraph\">Send those coverage denials to whoever handles payer contracting. Knowing the common <a href=\"https:\/\/pabau.com\/procedure-codes\/denial-codes-in-medical-billing\/\">denial codes<\/a> helps the team tell a contract problem from a coding one before anybody reworks the claim. The <a href=\"https:\/\/www.aapc.com\/codes\/hcpcs-codes-range\/\" target=\"_blank\" rel=\"nofollow noopener\">AAPC HCPCS lookup<\/a> is a solid secondary reference for confirming the S0316 description before submission.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.pabau.com\/cdn\/attachments\/pulse\/content-engine\/billing_codes\/hcpcs-code-s0316\/automate-claims-through-healthcode.webp\" alt=\"Automate claims and billing with Pabau\"\/><figcaption class=\"wp-element-caption\"><em>Pabau&rsquo;s claims dashboard tracks every S0316 submission, so your team spots a denial before the filing window closes.<\/em><\/figcaption><\/figure>\n\n\n\n<div style=\"height:35px;width:800px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h3 id=\"h-applicable-modifiers-for-s0316\" class=\"wp-block-heading\">Applicable modifiers for S0316<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">S-codes can carry standard HCPCS and CPT modifiers, depending on what the payer requires. The modifiers most relevant to S0316 are listed below. S-code modifier policy varies widely across Medicaid MCOs and commercial plans, so always check before you append one.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Modifier<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Description<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">When to apply<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">U1&ndash;U9 \/ UA&ndash;UD<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Medicaid-specific modifiers, defined by each state<\/td>\n<td style=\"padding:12px 16px;color:#374151\">When a state Medicaid plan needs a modifier to identify the program type or qualifying condition<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">GT<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Via interactive audio and video telecommunications<\/td>\n<td style=\"padding:12px 16px;color:#374151\">When the follow-up runs over telehealth and the payer accepts that delivery for this service<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">GQ<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Via asynchronous telecommunications system<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Store-and-forward telehealth delivery, where the payer permits it<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">95<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Synchronous telemedicine service rendered via real-time audio and video<\/td>\n<td style=\"padding:12px 16px;color:#374151\">The alternative to GT for commercial payers that require modifier 95 for telehealth<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">AH<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Clinical psychologist<\/td>\n<td style=\"padding:12px 16px;color:#374151\">When a psychologist delivers the follow-up and the payer wants the provider type identified<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Modifier policy for S-codes comes from the payer rather than from CMS. Confirm the requirements with each contracted plan before billing, and keep a note of them where your coders will see it.<\/p>\n\n\n\n<h2 id=\"h-related-hcpcs-codes-s0315-and-s0317\" class=\"wp-block-heading\">Related HCPCS codes: S0315 and S0317<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">S0316 is the middle code in the disease management program series. Coders should know all three to avoid sequencing errors and to apply the right code at each stage of a patient&rsquo;s participation. Practices that also run diabetes education should check <a href=\"https:\/\/pabau.com\/procedure-codes\/hcpcs-code-g0109\/\">G0109<\/a>, which sits outside this series but often lands on the same patients.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Code<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Full description<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Typical use case<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Payer applicability<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">S0315<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Disease management program; initial assessment and initiation of program<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Billed once at enrollment, as the baseline assessment of the chronic condition<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Medicaid MCOs and commercial payers with disease management contracts<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">S0316<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Disease management program, follow-up\/reassessment<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Ongoing follow-up visits after enrollment, reassessing goals and the care plan<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Medicaid MCOs and commercial payers with disease management contracts<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">S0317<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Disease management program; per diem<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Billed per day of program participation rather than per encounter<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Verify with the payer, as per diem arrangements differ by contract<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Practices billing across all three codes need an internal protocol that ties each code to a visit type and program phase. Miscoding S0315 as S0316 is a common audit trigger, particularly in Medicaid managed care reviews.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The per diem structure of S0317 is easy to miss, because it bills on a different unit from the other two codes. A practice on <a href=\"https:\/\/pabau.com\/industry\/metabolic-health-emr\/\">metabolic health EMR<\/a> can flag the program phase on the record itself. The coder then reads it off the chart instead of reconstructing it from the note.<\/p>\n\n\n\n<h2 id=\"h-documentation-requirements-for-s0316\" class=\"wp-block-heading\">Documentation requirements for S0316<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Disease management billing gets scrutinized more closely than routine office visit billing. Payers that contract these programs expect the note to show genuine participation, not a brief check-in. Thin documentation is the most frequent cause of S0316 denials and post-payment audits.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Each S0316 encounter note should contain the following core elements:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Proof of program enrollment:<\/strong> A reference to the patient&rsquo;s active program, naming the enrolled condition and the enrollment date or program identifier.<\/li>\n\n\n\n<li><strong>Reassessment of clinical goals:<\/strong> Current indicators such as HbA1c, blood pressure, or peak flow, compared against the goals set at program initiation.<\/li>\n\n\n\n<li><strong>Symptom and self-management review:<\/strong> Patient-reported data since the last visit, including symptom changes, adherence issues, or barriers to self-management.<\/li>\n\n\n\n<li><strong>Care plan updates:<\/strong> Any changes made after the reassessment, including referrals, medication changes, or adjusted self-management targets.<\/li>\n\n\n\n<li><strong>Patient education content:<\/strong> A brief note on what was taught or reinforced, specific to the enrolled program&rsquo;s condition.<\/li>\n\n\n\n<li><strong>Next steps and visit frequency:<\/strong> The planned follow-up interval and any actions still outstanding from the visit.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/pabau.com\/features\/patient-intake-software\/\">Digital intake forms<\/a> built around the program&rsquo;s requirements make it easier to capture every element at every visit. Free-text notes tend to lose one or two elements under audit, while a structured template anchors the note to the required content areas.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.pabau.com\/cdn\/attachments\/pulse\/content-engine\/billing_codes\/hcpcs-code-s0316\/customizable-consent-and-intake-forms.webp\" alt=\"Customizable consent and intake forms\"\/><figcaption class=\"wp-element-caption\"><em>Pabau&rsquo;s customizable intake forms give every disease management follow-up the same structure, so no required documentation element gets left out.<\/em><\/figcaption><\/figure>\n\n\n\n<div style=\"height:35px;width:800px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/pabau.com\/blog\/hipaa-compliance-software\/\">HIPAA-compliant documentation<\/a> is the baseline for every disease management record. Payer rules then add a second layer on top. Some Medicaid MCOs require these notes to be generated and signed within 24&ndash;48 hours of the encounter.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Check your contract addenda for that requirement before you set the clinical documentation workflow. The same notes carry your <a href=\"https:\/\/pabau.com\/blog\/medical-billing-compliance\/\">medical billing compliance<\/a> position in an audit, so the two reviews belong together.<\/p>\n\n\n        <div id=\"pro_tip\">\n            <div class=\"img\">\n                <svg width=\"42\" height=\"42\" viewBox=\"0 0 42 42\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M12.6383 19.5238C12.6632 21.2071 12.8734 22.9926 12.0685 24.5523C11.0341 26.8917 8.45076 28.169 7.56292 30.5918C6.63082 33.1061 7.19505 36.185 9.31371 37.9786C10.929 39.5678 13.4183 39.9873 15.6061 39.5463C17.4592 39.073 19.1049 37.8388 19.9706 36.1608C20.781 34.7141 20.7866 32.9904 20.5293 31.3985C20.1006 29.3092 18.3775 27.8705 16.9807 26.362C14.8814 24.1005 14.6684 20.6854 15.595 17.8915C16.4331 15.4768 19.0026 14.2344 20.0425 11.9461C20.7202 10.6769 20.7506 9.20327 20.6068 7.81304C20.1864 5.40098 18.3139 3.23631 15.8716 2.56674C13.9742 2.03969 11.8224 2.30052 10.1739 3.37614C8.70522 4.34688 7.5878 5.86618 7.28356 7.58178C6.76081 9.82981 7.53525 12.2822 9.20307 13.9118C10.7658 15.4741 12.4806 17.2273 12.6383 19.5238Z\"\n                        fill=\"#2BADD4\" \/>\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M22.7048 19.8387C22.6822 22.3279 24.4507 24.6234 26.7493 25.4682C28.0531 25.961 29.4725 25.9183 30.7989 25.5487C32.0575 24.9955 33.301 24.2237 34.0069 23.0092C34.8384 21.5811 35.2982 19.8286 34.7832 18.2094C34.3611 16.2507 32.8739 14.6541 31.0275 13.9426C28.6736 12.9595 25.8073 13.7942 24.1719 15.7001C23.2022 16.8366 22.6143 18.3326 22.7048 19.8387Z\"\n                        fill=\"#2BADD4\" \/>\n                <\/svg>\n            <\/div>\n            <div class=\"text\">\n                <h3>Pro Tip<\/h3>\n                <p>Audit five S0316 claims each quarter against your documentation checklist. Compare what the note contains with what the payer&rsquo;s contract requires. Documentation problems in disease management tend to repeat across every note, so a small sample surfaces the pattern early.<\/p>\n            <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-how-pabau-keeps-s0316-claims-clean\" class=\"wp-block-heading\">How Pabau keeps S0316 claims clean<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Most practices track disease management billing across three places at once. Program enrollment lives in one system, the reassessment note in another, and the claim in a third. The coder then rebuilds the patient&rsquo;s program phase from whichever record looks most current.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Practice management software like Pabau holds all three in the same patient record. The enrollment date, every reassessment note, and the submitted claim sit on one timeline. A coder can see at a glance whether the visit is an S0315 or an S0316.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/pabau.com\/features\/claims-management-software\/\">Claims management software<\/a> then carries the code and its modifiers straight through to submission, and tracks what comes back. Every subscription includes it, so billing, charting, and program tracking are not separate purchases.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The result is fewer S0316 denials caused by a wrong code choice. It also leaves a documentation trail that stands up when a Medicaid MCO asks to see it.<\/p>\n\n\n        <div id=\"book_a_demo\">\n            <div class=\"left-side\">\n                <div class=\"logo\">\n                    <img decoding=\"async\"\n                        src=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/01\/Logo.svg\"\n                        alt=\"Logo\"\n                        loading=\"lazy\"\n                    \/>\n                <\/div>\n\n                <h3 class=\"heading\">\n                    Bill disease management programs without the denials                <\/h3>\n\n                <p class=\"description\">\n                    Pabau&rsquo;s claims management software applies HCPCS codes and modifiers as you submit, tracks each claim&rsquo;s status, and keeps the reassessment note attached to it.                <\/p>\n\n                <div class=\"button-group\">\n                    <a href=\"\/book-demo\/\" class=\"btn btn-scale-effect btn-cta-color btn-md\">\n                        <span class=\"btn-text\">Book a demo<\/span>\n                        <div class=\"btn-icon btn-icon-right\" aria-hidden=\"true\">\n                            <svg\n                                width=\"14\"\n                                height=\"12\"\n                                viewBox=\"0 0 14 12\"\n                                fill=\"none\"\n                                xmlns=\"http:\/\/www.w3.org\/2000\/svg\"\n                            >\n                                <path\n                                    d=\"M0.75 4.77295C0.335786 4.77295 0 5.10874 0 5.52295C0 5.93716 0.335786 6.27295 0.75 6.27295V5.52295V4.77295ZM13.2803 6.05328C13.5732 5.76039 13.5732 5.28551 13.2803 4.99262L8.50736 0.219648C8.21447 -0.073245 7.73959 -0.073245 7.4467 0.219648C7.15381 0.512542 7.15381 0.987415 7.4467 1.28031L11.6893 5.52295L7.4467 9.76559C7.15381 10.0585 7.15381 10.5334 7.4467 10.8263C7.73959 11.1191 8.21447 11.1191 8.50736 10.8263L13.2803 6.05328ZM0.75 5.52295V6.27295L12.75 6.27295V5.52295V4.77295L0.75 4.77295V5.52295Z\"\n                                    fill=\"currentColor\"\n                                ><\/path>\n                            <\/svg>\n                        <\/div>\n                    <\/a>\n                <\/div>\n            <\/div>\n\n            <div class=\"right-side\">\n                <img decoding=\"async\"\n                    src=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/01\/Home-Page-Concept-4.webp\"\n                    alt=\"Pabau claims management dashboard\"\n                    loading=\"lazy\"\n                \/>\n            <\/div>\n        <\/div>\n        \n\n\n<h2 id=\"h-conclusion\" class=\"wp-block-heading\">Conclusion<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">S0316 is a straightforward code with an unforgiving edge. It only holds up when the record proves the patient was already enrolled and the visit was a genuine reassessment.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">So the work sits upstream of the claim. Decide how your practice records program enrollment, who confirms the phase before coding, and what a reassessment note has to contain. Once those three answers are written down, the code choice stops being a judgment call.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The trade-off worth remembering is that S0316 does not scale with clinical complexity the way an E\/M code does. A visit that genuinely escalates may belong elsewhere. <a href=\"https:\/\/pabau.com\/book-demo\/\">Book a demo<\/a> to see how Pabau ties disease management notes to the claims that depend on them.<\/p>\n\n\n        <div id=\"expert_picks\">\n            <div class=\"header\">\n                                    <img decoding=\"async\" src=\"https:\/\/pabau.com\/wp-content\/uploads\/2025\/11\/Expert-Picks.svg\" alt=\"Continue your research\" height=\"42\" width=\"42\">\n                                <h3>Continue your research<\/h3>\n            <\/div>\n            <div class=\"content\">\n                                                            <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Worried a disease management claim will land too late?<\/strong> <a href=\"https:\/\/pabau.com\/blog\/timely-filing-limits\/\">Timely filing limits<\/a> sets out how long each payer type gives you and what to do when a deadline slips.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Need approval before a program visit goes ahead?<\/strong> <a href=\"https:\/\/pabau.com\/blog\/prior-authorization-process\/\">Prior authorization process<\/a> walks through the request, the follow-up, and the appeal when a payer says no.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Still waiting on a Medicaid MCO contract?<\/strong> <a href=\"https:\/\/pabau.com\/blog\/how-to-get-credentialed-with-insurance-companies\/\">How to get credentialed with insurance companies<\/a> covers the paperwork and the timelines that decide when you can start billing.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Billing patients who pay out of pocket as well?<\/strong> <a href=\"https:\/\/pabau.com\/templates\/superbill-template\/\">Superbill template<\/a> gives you a ready-made form with the code, diagnosis, and provider fields already laid out.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Deciding how to send claims electronically?<\/strong> <a href=\"https:\/\/pabau.com\/blog\/claim-md-clearinghouse\/\">Claim MD clearinghouse<\/a> explains what a clearinghouse does to a claim between your practice and the payer.<\/p>\n                        <\/div>\n                                                <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-frequently-asked-questions\" class=\"wp-block-heading\">Frequently asked questions<\/h2>\n\n\n\n<div class=\"schema-faq wp-block-yoast-faq-block\"><div class=\"schema-faq-section\" id=\"faq-question-1787038595088\"><h3 class=\"schema-faq-question\">What is HCPCS code S0316?<\/h3> <p class=\"schema-faq-answer\">HCPCS code S0316 is a Level II S-code for disease management program follow-up and reassessment services. It bills ongoing reassessment visits for patients already enrolled in a structured program. Those programs commonly cover diabetes, heart failure, asthma, and hypertension. Many Medicaid managed care plans and commercial payers accept the code, but traditional Medicare fee-for-service usually does not.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1787038595089\"><h3 class=\"schema-faq-question\">Is S0316 covered by Medicare?<\/h3> <p class=\"schema-faq-answer\">Traditional Medicare fee-for-service does not cover S0316. S-codes are temporary non-Medicare codes and do not appear on the CMS Physician Fee Schedule. Some Medicare Advantage plans cover S0316 under supplemental benefits, so verify directly with the individual plan before billing.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1787038595090\"><h3 class=\"schema-faq-question\">What is the difference between S0315 and S0316?<\/h3> <p class=\"schema-faq-answer\">S0315 covers the initial assessment and program initiation when a patient first enrolls in a disease management program. S0316 covers every follow-up and reassessment visit after that enrollment. Billing S0316 for a first program visit, or S0315 for a follow-up, usually results in a denial.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1787038595094\"><h3 class=\"schema-faq-question\">How is S0317 different from S0316?<\/h3> <p class=\"schema-faq-answer\">S0316 bills a single follow-up or reassessment visit inside a disease management program. S0317 is a per diem code, so it bills by day of program participation rather than by encounter. The two are not interchangeable, and the payer contract decides which arrangement applies.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1787038595091\"><h3 class=\"schema-faq-question\">What payers accept HCPCS code S0316?<\/h3> <p class=\"schema-faq-answer\">Many Medicaid managed care organizations and commercial insurers accept S0316 under contracted disease management programs. Coverage varies by state Medicaid plan and by individual commercial contract. Traditional Medicare does not cover the code. Always verify payer-specific coverage before submitting claims.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1787038595092\"><h3 class=\"schema-faq-question\">What modifiers can be used with S0316?<\/h3> <p class=\"schema-faq-answer\">Common modifiers include state-defined Medicaid modifiers such as U1 to U9 and UA to UD. Telehealth modifiers also apply: GT for synchronous video, GQ for asynchronous delivery, and modifier 95 for commercial plans. Provider-type modifiers such as AH cover clinical psychologists. Requirements vary by payer, so confirm with each contracted plan.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1787038595093\"><h3 class=\"schema-faq-question\">What documentation is required to support an S0316 claim?<\/h3> <p class=\"schema-faq-answer\">An S0316 claim needs documentation showing active program enrollment and a reassessment of clinical goals against baseline measurements. The note should also record symptoms and self-management data, any care plan updates from the visit, and the patient education delivered. Individual payer contracts may add further requirements on top.<\/p> <\/div> <\/div>\n\n","protected":false},"excerpt":{"rendered":"<p>HCPCS code S0316 is the billing code for disease management program follow-up and reassessment services. Report it when a patient already enrolled in a structured program attends a visit to review progress, adjust goals, or reassess their care plan. It belongs to HCPCS Level II, the code system maintained by the Centers for Medicare and [&hellip;]<\/p>\n","protected":false},"author":82,"featured_media":183373,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_yoast_wpseo_linkdex":"88","_yoast_wpseo_content_score":"60","_yoast_wpseo_is_cornerstone":"","_yoast_wpseo_keywordsynonyms":"[\"\",\"\",\"\",\"\",\"\",\"\"]","_yoast_wpseo_focuskw_text_input":"","_seo_original_html":"","footnotes":""},"categories":[1433,1548],"tags":[2983,1619,1611,3814,2508],"class_list":["post-183374","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-billing-codes","category-hcpcs","tag-chronic-disease-management","tag-hcpcs-billing","tag-hcpcs-codes","tag-medicaid-billing","tag-medical-coding"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v28.2 (Yoast SEO v28.2) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>HCPCS code S0316: Coverage, modifiers and billing (2026)<\/title>\n<meta name=\"description\" content=\"S0316 bills follow-up visits inside a disease management program. Medicaid MCOs and commercial payers cover it, Medicare usually does not.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/pabau.com\/fr\/procedure-codes\/hcpcs-code-s0316\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"HCPCS code S0316: Coverage, modifiers and billing (2026)\" \/>\n<meta property=\"og:description\" content=\"S0316 bills follow-up visits inside a disease management program. Medicaid MCOs and commercial payers cover it, Medicare usually does not.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/pabau.com\/fr\/procedure-codes\/hcpcs-code-s0316\/\" \/>\n<meta property=\"og:site_name\" content=\"Pabau\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/Pabau\/\" \/>\n<meta property=\"article:published_time\" content=\"2026-08-18T13:18:25+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2026-08-18T13:39:32+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/08\/hcpcs-code-s0316.webp\" \/>\n\t<meta property=\"og:image:width\" content=\"1200\" \/>\n\t<meta property=\"og:image:height\" content=\"630\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/webp\" \/>\n<meta name=\"author\" content=\"Maja Popovska\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:creator\" content=\"@pabaucrm\" \/>\n<meta name=\"twitter:site\" content=\"@pabaucrm\" \/>\n<meta name=\"twitter:label1\" content=\"\u00c9crit par\" \/>\n\t<meta name=\"twitter:data1\" content=\"Maja Popovska\" \/>\n\t<meta name=\"twitter:label2\" content=\"Dur\u00e9e de lecture estim\u00e9e\" \/>\n\t<meta name=\"twitter:data2\" content=\"13 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/hcpcs-code-s0316\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/hcpcs-code-s0316\\\/\"},\"author\":{\"name\":\"Maja Popovska\",\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/#\\\/schema\\\/person\\\/b00aec1dd379f0ddcf6137d78e2a21db\"},\"headline\":\"HCPCS code S0316: Disease management program follow-up\\\/reassessment\",\"datePublished\":\"2026-08-18T13:18:25+00:00\",\"dateModified\":\"2026-08-18T13:39:32+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/hcpcs-code-s0316\\\/\"},\"wordCount\":2735,\"publisher\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/hcpcs-code-s0316\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/08\\\/hcpcs-code-s0316.webp\",\"keywords\":[\"Chronic disease management\",\"Hcpcs Billing\",\"Hcpcs Codes\",\"Medicaid Billing\",\"Medical Coding\"],\"articleSection\":[\"Billing Codes\",\"HCPCS\"],\"inLanguage\":\"fr-FR\"},{\"@type\":[\"WebPage\",\"FAQPage\"],\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/hcpcs-code-s0316\\\/\",\"url\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/hcpcs-code-s0316\\\/\",\"name\":\"HCPCS code S0316: Coverage, modifiers and billing (2026)\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/hcpcs-code-s0316\\\/#primaryimage\"},\"image\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/hcpcs-code-s0316\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/08\\\/hcpcs-code-s0316.webp\",\"datePublished\":\"2026-08-18T13:18:25+00:00\",\"dateModified\":\"2026-08-18T13:39:32+00:00\",\"description\":\"S0316 bills follow-up visits inside a disease management program. 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It combines scheduling, electronic health records, clinical forms, payments, marketing automation, reporting, and patient engagement tools into one secure cloud system to help practices streamline operations and grow their business.\",\"foundingDate\":\"2011-10-20\",\"numberOfEmployees\":{\"@type\":\"QuantitativeValue\",\"minValue\":\"201\",\"maxValue\":\"500\"}},{\"@type\":\"Person\",\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/#\\\/schema\\\/person\\\/b00aec1dd379f0ddcf6137d78e2a21db\",\"name\":\"Maja Popovska\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"fr-FR\",\"@id\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/06\\\/cropped-Maja-Popovska_WP-1-96x96.jpeg\",\"url\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/06\\\/cropped-Maja-Popovska_WP-1-96x96.jpeg\",\"contentUrl\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/06\\\/cropped-Maja-Popovska_WP-1-96x96.jpeg\",\"caption\":\"Maja Popovska\"},\"description\":\"Maja is a Senior Content Writer at Pabau, where she covers everything from practice management and compliance to medical aesthetics and patient experience. Off the clock: binging true crime docuseries, baking and dreaming about travel.\",\"url\":\"https:\\\/\\\/pabau.com\\\/fr\\\/blog\\\/author\\\/maja-popovska\\\/\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/hcpcs-code-s0316\\\/#faq-question-1787038595088\",\"position\":1,\"url\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/hcpcs-code-s0316\\\/#faq-question-1787038595088\",\"name\":\"What is HCPCS code S0316?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"HCPCS code S0316 is a Level II S-code for disease management program follow-up and reassessment services. It bills ongoing reassessment visits for patients already enrolled in a structured program. Those programs commonly cover diabetes, heart failure, asthma, and hypertension. Many Medicaid managed care plans and commercial payers accept the code, but traditional Medicare fee-for-service usually does not.\",\"inLanguage\":\"fr-FR\"},\"inLanguage\":\"fr-FR\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/hcpcs-code-s0316\\\/#faq-question-1787038595089\",\"position\":2,\"url\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/hcpcs-code-s0316\\\/#faq-question-1787038595089\",\"name\":\"Is S0316 covered by Medicare?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"Traditional Medicare fee-for-service does not cover S0316. S-codes are temporary non-Medicare codes and do not appear on the CMS Physician Fee Schedule. 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