Physicians Could Be Paid for Advance Care Planning Consultations in 2016
The Centers for Medicare and Medicaid Services (CMS) has released proposed changes to the Medicare physician fee schedule via the proposal: Revisions to Payment Policies under the Physician Fee Schedule and Other Revisions to Part B for C Y 2016. The changes for calendar year 2016 could include payment to physicians for advance care planning sessions they have with patients, family member(s) and/or surrogate.
The National Association for Home Care & Hospice (NAHC) has a long-held position supporting advance care consultations as part of patient planning and decision-making relative to serious illness, and joined with other organizationsearlier this year in urging CMS to include coverage of such planning in its 2016 physician payment rule. NAHC President Val J. Halamandaris pledged the association’s support of CMS’ proposal, saying, “We share the widely held belief that Medicare beneficiaries with serious health conditions desire and need expanded opportunities for discussion of their conditions, the range of treatment options available, and their personal wishes relative to their care as these health conditions progress. CMS’ proposed coverage of advance care planning is a vital step toward improving quality of care and ensuring patient involvement and self-determination in the health care decision-making process. Its purpose is to allow patients—on a voluntary basis—to better understand the options available to them and to make care choices that best suit their interests and beliefs. We applaud CMS’ proposal to empower consumers in this way, and support this change as part of an overall effort to improve care for individuals with life-threatening conditions."
In CY2015 the CPT Editorial Panel of the American Medical Association created two new codes describing advance care planning (ACP) services but there was no separate payment for the services. In the final rule for the physician fee schedule (PFS) for 2015, CMS indicated that it would consider whether to pay for CPT codes 99497 and 99498 after it had the opportunity to go through notice and comment rulemaking. CMS received many public comments to the final rule recommending that these two CPT codes be recognized as active codes and make separate payment for ACP services. For CY 2016, CMS is proposing to assign CPT codes 99497 and 99498 PFS status indicator “A,” which is defined as: “Active code. These codes are separately payable under the PFS.
CMS is accepting comments on the proposal until September 8, 2015. Descriptors for the codes are below:
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);
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).
As part of the proposed rule, CMS seeks comment on this proposal, as well as on whether payment is needed for advance care planning services and what type of incentives this proposal creates. In addition, CMS is seeking comment on whether payment for advance care planning is appropriate in other circumstances such as an optional element, at the beneficiary’s discretion, of the annual wellness visit (AWV).