CMS Issues Instruction for Payment of Advance Care Planning Services as Part of Annual Wellness Visit under Part B
January 5, 2016 09:21 AM
On October 30, 2015, the Centers for Medicare & Medicaid Services (CMS) made public a final rule governing Medicare Revisions to Payment Policies under the Physician Fee Schedule and Other Revisions to Part B for CY2016, which includes information on payment for advance care planning (ACP) services. The Rule was published in the Federal Register on November 16. Previous NAHC Report coverage on the rule is available here and here. As part of the final rule, CMS announced activation of:
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)].
These activities may be billed on the same day or on a different day from billing of other Evaluation and Management (E&M) services, but may not be billed on the same date of service as certain critical care services including neonatal and pediatric critical care.ACP services which are not provided in conjunction with the Annual Wellness Visit (AWV) are subject to the Part B deductible/coinsurance and are being implemented through the annual Medicare Physician Fee Schedule Database update.
Most recently, CMS has issued Transmittal 3428/Change Request 9271, effective January 1, 2016, to implement a waiver of the Part B deductible and coinsurance requirements when a patient voluntarily elects Advance Care Planning (ACP) as an optional element of the AWV. CMS’ rationale for this waiver is that when ACP services are elected/furnished on the same day and by the same provider as performs the AWV, these services are considered a preventive service. A link to Transmittal 3428/CR 9271 and its accompanying MedLearn Matters article (MM 9271), which contain additional detail, are available here.