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Reimbursement of Advance Care Planning by Medicare Has Support of Hospitalists


On Oct. 31, 2014, the Centers for Medicare and Medicaid Services (CMS) published the 2015 Medicare Physician Fee Schedule (MPFS) Proposed Rule. Included in the rule was an interesting discussion about the potential for Medicare to begin paying for advance care planning services.

CMS describes these services as “the explanation and discussion of advance directives, such as standard forms [with completion of such forms, when performed], by the physician or other qualified healthcare professional; face-to-face with the patient, family member[s], and/or surrogate.”

To enable billing for these services, CMS suggested the use of two new AMA-created CPT codes (99497 and 99498), which allow providers to be reimbursed for their consultation in end-of-life care conversations and also encourage the conversations to occur prior to their being clinically necessary. The codes are designed to cover substantive discussions about goals of care, treatment options, values, and preferences when it comes to end-of-life care planning.

This development was welcome news for many hospitalists who, too often, are called upon to participate in end-of-life care conversations that are long overdue. Hospitalists know these conversations help to ensure that patient wishes are respected at the end of life and also prevent the use of unwanted treatments or interventions.

In the best scenario, not only will Medicare payment for these codes encourage physicians to start these conversations prior to a stressful inpatient stay, but reimbursement also allows hospitalists and other relevant specialists to provide patients with the proper time, space, and expertise these important conversations require.

Disappointingly, CMS did not agree to start reimbursing the advance care planning codes for 2015; however, they did signal openness to the idea of reimbursing them in the future, leaving this aspect of an otherwise final rule open for further comment.

For its part, SHM responded with follow-up comments that both express disappointment with the CMS decision and further elaborate on the value of these codes for both hospitalists and patients.

Moving forward, hospitalists can be assured this is not a one-off issue for SHM.

For well over a year, SHM’s Public Policy Committee has been actively supporting legislation introduced by Rep. Earl Blumenauer (D-Ore.). The Personalize Your Care Act (H.R. 1173), similar to the CMS proposal, would establish Medicare reimbursement for voluntary advance care planning consultations, along with other beneficial treatment of advance care plans.

Nearly 200 members of SHM’s Grassroots Network have supported these efforts by sending letters to their own representatives in favor of Rep. Blumenauer’s bill. Moving into the new year and the 114th Congress, continued pressure will be placed on CMS, and plans are in motion to continue SHM support for a reintroduced Personalize Your Care Act.

Hospitalists wishing to assist in these efforts need only join SHM’s Grassroots Network and keep their eyes open for opportunities to help—they will be forthcoming.

To get involved today, visit

Josh Boswell is SHM’s director of government relations.

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