The Centers for Medicare and Medicaid Services has finalized its proposal to reimburse physicians and other eligible providers for providing advance care planning services to Medicare beneficiaries. This policy will allow individual beneficiaries to receive the care they want when experiencing advanced illness, including but not exclusively at the end of life.
Under the final rule, CMS establishes Medicare coverage for two Current Procedural Terminology (CPT) codes for advance care planning, effective for use for services provided on or after January 1, 2016. These codes are billable under Medicare Part B. They can be used by any physician or non-physician practitioner who is entitled to bill Part B independently, provided the services are within their scope of practice where they are licensed. Like other Part B services, beneficiary cost sharing requirements will apply to ACP services, unless they are provided in conjunction with the Annual Wellness Visit. Most hospice physicians who do not bill Part B for physician services will not use these codes and hospices will not be using these codes for Part A hospice physician services, but physicians providing palliative care consulting services and billing under Part B may bill these codes.
The final rule creates separate Medicare billing codes and provider reimbursement rates for advance care planning, and will allow physicians to include advance care planning as part of patients’ annual check-ups. Physicians can also continue to be reimbursed for such discussions that occur during a patient’s initial visit after enrolling in Medicare, which is already covered under the program.
CMS said the rule is “consistent with recommendations from a wide range of stakeholders and bipartisan members of Congress.” Patrick Conway, CMS, CMO said he recognizes “how important these discussions are for patients and families. We believe patients and families deserve the opportunity to discuss these issues with their physician and care team.”
Other final rule details
- Finalizes a 0.5% increase in payment for the physician fee schedule in CY 2016, as called for under the Medicare Access and CHIP Reauthorization Act of 2015.
- Wil apply the Value-Based Payment Modifier in the CY 2018 payment adjustment period to physician assistants, nurse practitioners, clinical nurse specialists, and certified registered nurse anesthetists in groups and to such non-physician eligible professionals who are solo practitioners;
- Waive the Value-Based Payment Modifier for providers participating in the CMS Innovation Center’s value-based demonstration programs; and
- Finalizes several new features for Medicare’s Physician Compare website, although CMS scrapped it proposal to put a green check mark next to providers that received payment bonuses for their performance on quality and cost measures (Rubenfire, Modern Healthcare, 10/30; AHA News, 10/30; CMS fact sheet, 10/30).