Bioethics Blogs

Medicare Coverage for Advance Care Planning

CMS has just published a major proposed rule addressing changes to the physician fee schedule, and other Medicare Part B payment policies. 

Significant among these changes, the proposed rule makes the two advance care planning codes established in 2015 “active” and begins the process of allowing physicians to code and be paid for advance care planning discussions.


I have written about the history of CMS and advance care planning here and here.  Comments on the proposed rule are due by September 8, 2015.  Here is the relevant text: 
 

c. Advance Care Planning Services

For CY 2015, the CPT Editorial Panel created two new codes describing advance care planning (ACP) services: CPT code 99497 (Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health professional; first 30 minutes, face-to-face with the patient, family member(s) and/or surrogate); and an add-on CPT code 99498 (Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health professional; each additional 30 minutes (List separately in addition to code for primary procedure)). 

In the CY 2015 PFS final rule with comment period (79 FR 67670-71), we
assigned a PFS interim final status indicator of ‘‘I’’ (Not valid for Medicare purposes. Medicare uses another code for the reporting and payment of these services) to CPT codes 99497 and 99498 for CY 2015. We said that we would consider whether to pay for CPT codes 99497 and 99498 after we had the opportunity to go through notice and comment rulemaking.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.