Compensation for Advance Care Planning Services Proposed

The CY 2015 proposed physician fee schedule which will be published in the Federal Register on July 15, 2015, contains a proposal to include separate reimbursement for advance care planning, including the discussion of advance directives by physicians or other qualified health professionals.

CPT Codes 99497 (first 30 minutes face-to-face advance care planning) and 99498 (additional 30 minutes) would be used to report the advance care planning services which could include the explanation and completion of standard forms.

CMS noted that contractors will be responsible for local coverage decisions in absence of a national coverage determination regarding the use of these codes.

CMS is proposing that advance care planning codes could occur on the same day or a different day as an office visit/evaluation and management code.

The advance care planning codes would be subject to Medicare’s “reasonable and necessary” requirements and could occur in conjunction with the management or treatment of a patient’s current condition.
An example that was provided in the proposed rule was that of a 68 year old patient with heart failure and diabetes. CMS stated that, in addition to discussing short term treatment and long term treatment such as transplant options, it would also be appropriate to address treatment options and planning such as the possibility of the patient suffering a health event that adversely affects the patient’s decision making capacity.

CMS also is seeking comments as to whether this code could also be included as an optional element of the beneficiary’s annual wellness visit (AWV). The deadline for submitting comments is September 8, 2015.

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