CMS Proposes Paying for End-of-Life Discussions

July 08, 2015

The Centers for Medicare & Medicaid Services (CMS) today proposed to pay physicians beginning next year for optional end-of-life discussions with Medicare patients, a subject that helped spark the "death panels" furor during the healthcare reform debate of 2009 and 2010.

CMS introduced two CPT billing codes for end-of-life discussions, also called advance-care planning, in its physician fee schedule for 2015, but did not make them payable. CPT code 99497 covers a discussion of advance directives with the patient, a family member, or surrogate up to 30 minutes. The add-code of 99498 covers an additional 30 minutes of discussion.

The proposed fee schedule for 2016, released today, would activate these two CPT codes for payment, but does not set a rate. The draft regulation notes that making these billing codes active "does not mean that Medicare has made a national coverage determination regarding the service." When there is no national Medicare policy, the decision to reimburse physicians for an active billing code falls to so-called Medicare administrative contractors (MACs) — typically private health insurers — across the country that process Medicare claims, according to CMS.

A CMS spokesperson told Medscape Medical News that if the proposal to pay for advance-care planning becomes final, but does not become a national policy as such, MACs would pay for the two new billing codes unless they took the trouble to contest them by issuing a Local Coverage Determination.

Advance-care planning can be a reimbursable component of a one-time Welcome to Medicare visit, but the agency noted today that patients may not need to talk about advance directives when they first enroll in the program.

An early version of the Affordable Care Act would have paid physicians separately for advance-care planning. However, the legislation's authors withdrew this provision after critics such as former Republican vice presidential candidate Sarah Palin called it an attempt to save money by hastening the death of the elderly. Such charges were linked to the fictional "death panels" that the law supposedly would establish.

The Obama administration later withdrew a regulation making advance-care planning a reimbursable component of annual wellness visits under Medicare in the face of similar criticism.

Organized medicine has long supported making advance-care planning a reimbursable, stand-alone service. Discussions about advance directives, hospice care, and other end-of-life issues can go unpaid in a fee-for-service environment, of course, but physicians then lack a financial incentive to make time for them. In May, the American Medical Association, the American College of Physicians, and dozens of other medical societies and healthcare organizations — along with AARP — urged the US Department of Health & Human Services (HHS) to start paying for the two new billing codes for this service.

"Published, peer-reviewed research shows that [advance-care planning] leads to better care, higher patient and family satisfaction, fewer unwanted hospitalizations, and lower rates of caregiver distress, depression, and lost productivity," the groups said in a letter to HHS Secretary Sylvia Burwell.

More information about today's CMS announcement is available on the agency's website.


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