NHPCO Applauds New Reimbursement for Advance Care Planning Conversations

Provision will help Medicare beneficiaries make more informed decisions on care

Nov 02, 2015, 12:58 ET from National Hospice and Palliative Care Organization

ALEXANDRIA, Va., Nov. 2, 2015 /PRNewswire-USNewswire/ -- The CY2016 Physician Fee Schedule Final Rule, (PDF) posted by the Centers for Medicare and Medicaid Services on Friday, October 30, includes two Current Procedural Terminology codes for advance care planning. The National Hospice and Palliative Care Organization enthusiastically supports the new rule that provides for physician compensation for what are important and complicated conversations with patients who are Medicare beneficiaries.

In the CY2015 final rule, published late in 2014, CMS established the two CPT codes for physicians to document advance care planning conversations, one code for the first 30 minutes, and a second add-on code for additional 30 minute conversations.  Now, in the CY2016 final rule, reimbursement is provided.

The codes are effective for use for services provided on or after January 1, 2016.  By their nature, these codes are billable under Medicare Part B.  They can be used by any physician or non-physician practitioner who bills Part B for their services, including those providing palliative care services.  Most hospice physicians who do not bill for Part B physician services will not use these codes.  

Conversations will likely involve patient goals of care, discussions of advance care planning  and help understanding advance directives which are a helpful tool for patients, their family caregivers, and the professionals caring for them during the course of a serious illness.  

NHPCO offers a video on Planning for End of Life Care.

"NHPCO has long championed the need for Americans to talk about and document their healthcare preferences with their loved ones and healthcare professionals," said J. Donald Schumacher, NHPCO president and CEO.   "More and more Americans are facing advanced illness and are aging with multiple chronic health conditions, so it's now more important than ever to have these vital conversations."

In the Institute of Medicine report Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life, advance care planning and clinician-patient communication is cited as a critical opportunity for improvement.   The IOM committee states that advance care planning can begin at any age or condition of health, and should include family members and healthcare providers.

"Patients deserve assistance with advance care planning and it's essential that these conversations take place before a crisis happens," says Schumacher.  "We are pleased that CMS recognizes the value of these meaningful discussions between physicians and their patients."

As an organization committed to increasing awareness of advance care planning, NHPCO provides free information and tools to the public.  NHPCO's CaringInfo (its consumer information website) at caringinfo.org/stateaddownload has state-specific advance directive forms and information on advance care planning that can be downloaded at no cost.  Each state's advance directive is legally reviewed on an annual basis and meets each state's statutory requirements.

Anita Brikman
NHPCO Senior Vice President of Strategic Communications
Ph: 703-837-3154

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SOURCE National Hospice and Palliative Care Organization