CMS considers separate payment for advance care planning

The Centers for Medicare & Medicaid Services (CMS) has released its proposed Medicare Physician Fee Schedule for the 2016 calendar year. Among the many updates is a proposal to pay physicians separately for providing advance care planning to Medicare patients.

Medicare currently pays for such services as part of the “Welcome to Medicare” visit, but patients may not need such services during that first visit. Proponents have said providing a separate payment for advance care planning gives physicians and Medicare patients greater flexibility and the ability to use these services when they are most needed.

CMS is actually proposing two CPT codes: 99497 for the first 30 minutes of advance care planning and 99498 for each additional 30 minutes.

For example, a patient who has been diagnosed and is receiving treatment for heart failure may want to discuss long-term treatment options, such as a heart transplant. The patient may also want to discuss advance care planning in case a health event diminishes his or her decision-making capacity. Under the proposal, the physician in this scenario could report a standard evaluation and management (E/M) code for the E/M service and 99497, as well as 99498 if appropriate. Note, the E/M and advance care planning services would not necessarily have to happen on the same day.

CMS is taking public comments on this and other proposals in the Medicare PFS through Sept. 8. It plans to issue the final rule by Nov. 1.