Getting Paid for Advance Care Planning

Organizations Prod HHS to Recognize Existing CPT Codes

May 27, 2015 11:30 am News Staff

The AAFP recently joined more than 60 other organizations in support of Medicare payment for advance care planning (ACP) services.

[Son and elderly mom sitting on sofa while medical professional takes notes]

In a May 12 letter(3 page PDF) to HHS Secretary Sylvia Burwell, the organizations urged HHS to ensure that separate payment for CPT codes 99497 and 99498 -- carefully crafted by CPT Editorial Panel experts with input from a wide variety of stakeholders -- were made available to health care professionals in 2016.

This latest letter reiterates the AAFP's concerns -- noted in a separate appeal to (then) CMS Administrator Marilyn Tavenner at the close of 2014 -- when CMS ruled the codes invalid for Medicare purposes because another code was already available.

As a reminder to family physicians, the provision of complex ACP services involves one or more voluntary meetings with the patient (family and/or other caregiver involvement is optional) lasting 30 minutes or longer during which the patient's values and preferences are discussed and documented.

Those discussions can then be used as a guide for decision-making regarding future care for serious illnesses.

"Published peer-reviewed research shows that ACP leads to better care, higher patient and family satisfaction, fewer unwanted hospitalizations, and lower rates of caregiver distress, depression and lost productivity," wrote the organizations.

They pointed out the importance of advance care planning for Medicare patients who often battle multiple chronic illnesses and depend on family and other caregivers for support in a home setting.

The organizations noted widespread consensus about the value of the services, including calls for increased use of advance care planning from the Institute of Medicine and the CDC. "ACP has become a standard of care and consensus regarding its value is widespread," they wrote.

Allowing physicians to bill separately for ACP services would encourage provision of the services and, importantly, allow Medicare to track use of the services and then assess their impact on both the effectiveness of care and patients' quality of life.

"Programs like the physician quality reporting system already ask physicians to report on whether or not they did advance care planning with patients. Payment for this service will align with these quality reporting mechanisms and promote higher quality and value in the system," argued the organizations.

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