How to Bill for Voluntary Advance Care Planning Conversations

By Seasons | January 11, 2021

pcp

According to the 2014 Institute of Medicine Landmark Report on Dying In America,Clinicians need to initiate conversations about end-of-life care choices and work to ensure that patient and family decision making is based on adequate information and understanding.

Americans struggle to outline their care wishes. dying in america key findingsConversations around life support, medical power of attorney, or what patients want done (or not done) in future situations doesn’t always come naturally in the U.S. According to a 2014 Health Affairs study, only 36% of citizens had completed an advance directive. 

However, as we move towards value-based healthcare it’s clear that these conversations must take place. 25% of Medicare spending occurs within the last year of life, and a significant portion of that is on care that patients claim they’d prefer not to have. Advance directives, a clearly outlined medical power of attorney (MPOA), and care wishes are all critically important primary care tools. 

Who has the time? 

While widespread conversations about future care plans are a laudable goal, the reality is that healthcare professionals are stretched thin. Primary care providers are being asked to work with ever greater efficiency, see more patients, and document in complex electronic health record systems. How do these delicate and lengthy conversations fit within a busy and oft-strained primary care practice? 

Medicare will reimburse physicians or other qualified health care professionals for advance care planning conversations 

Medicare provides two different Current Procedural Terminology (CPT) codes to reimburse for these critical discussions. By using these codes, physicians and other qualified health care professionals can be reimbursed for time spent discussing advance directives working to help codify future care wishes.  

Those codes are: 

CPT Codes 

Billing Code Descriptors 

2020 Reimbursement Rates (geographically adjusted)1 

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 care professional; first 30 minutes, face-to-face with the patient, family member(s), and/or surrogate 

$84 (facility) 

$91 (non-facility) 

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 care professional; each additional 30 minutes (List separately in addition to code for primary procedure) 

$80 (facility and non-facility) 

 

Important notes: 

  • There are no limits on the number of times a physician can report ACP for a given patient in a given time period. 
  • ACP services can be offered in facility and non-facility settings 
  • Medicare pays for ACP as either: 
    • An optional element of the patient’s annual Medicare Wellness Visit 
    • A separate Medicare Part B medically necessary service

Advance Care Planning is not a one-time event 

These notes are especially important because good advance care planning can’t be completed in 30 or even 60 minutes. The best advance care plans are the result of an ongoing conversation between a patient, their healthcare proxy, their family, and their physician. It may take several sessions to get a patient comfortable with the idea of talking about future care choices openly and honestly. It may take a few more visits after that to properly codify those wishes in a given state’s legal forms. 

By using these CPT codes, Medicare is allowing you the time you need to have a productive discussion about possible future care needs and impart a deeper understanding of what future healthcare might look like for your patients and families. 

Resources: 

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