Medicare Approves Payment for End-of-Life Counseling


October 30, 2015

A proposal too hot to handle in the nascent days of the Affordable Care Act (ACA) became a reality today when the Centers for Medicare and Medicaid Services (CMS) approved payment for voluntary end-of-life counseling as part of its 2016 Medicare physician fee schedule.

The new policy will help seniors "make important decisions that give them control over the type of care they receive and when they receive it," CMS said in a news release.

The decision to pay for so-called advance-care planning (ACP) initially will fall to Medicare administrative contractors (MACs) that process claims on behalf of Medicare.

An early version of the healthcare reform law called for paying physicians under Medicare for ACP — that is, discussing advance directives, hospice care, and other end-of-life issues with patients. Supporters of the idea said it would address the problem of physicians not taking the time for such important conversations because they were not reimbursable in a fee-for-service system. However, that provision was dropped after ACA critics erroneously claimed that the law would establish "death panels" with the goal of reducing healthcare costs by culling sickly seniors from the population.

CMS reintroduced the proposal to pay for ACP to far less flak this summer in the first draft of its Medicare physician fee schedule for 2016. Today, the agency released the final version of the fee schedule, with the proposal intact.

The American Medical Association and many other medical societies support paying for end-of-life counseling, although the small but vocal Association of American Physicians and Surgeons contends that such fees would "create financial incentives to persuade patients to consent to the denial of care."

In the final version of the fee schedule, CMS said it received roughly 725 public comments on its ACP proposal since it was first floated this summer. The agency noted that "the vast majority of comments indicate that most patients desire access to ACP services as they prepare for important medical decisions."

Medicare Administrative Contractors Will Implement New Policy

There are two current procedural terminology (CPT) billing codes for ACP. CPT code 99497 covers a discussion of advance directives with the patient, a family member, or surrogate for up to 30 minutes. An additional 30 minutes of discussion takes the add-on code of 99498. Medicare will pay roughly $86 for 99497 and $75 for 99498 when the counseling occurs in a physician's office, according to the AMA.

Under next year's fee schedule, ACP also can be an optional — and reimbursable — element of Medicare's annual wellness visit.

CMS is slowly easing into this new arrangement. Right now, Medicare has not made what it calls a "national coverage determination" on paying for ACP. That decision would be made instead by the MACs — many of which are commercial insurers — that process claims for Medicare. A CMS spokesperson told Medscape Medical News earlier this year that MACs normally would pay for the two new billing codes in this circumstance unless they took the trouble to contest them by issuing a Local Coverage Determination.

CMS said in its final 2016 fee schedule that it "may be advantageous to allow time for implementation and experience with ACP services" under the auspices of local MACs before the agency considers setting a "controlling national policy."

More information about the final 2016 Medicare physician fee schedule is available on the CMS website.


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