Beneficiaries don’t necessarily have to be present during advance care planning discussions for providers to bill for advance care planning. That guidance was included in Q&As CMS released March 22.
CMS revealed Oct. 30, 2015, in the final 2016 Medicare physician fee schedule that doctors will receive substantial payments for advance care planning and an opportunity to bill it without copayment. The codes will pay a nationalized non-facility fee of $85.99 and $74.88, respectively (
HHL 2/1/16).
The dozen questions and answers CMS released March 22 provide additional clarification.
In response to a question about whether a beneficiary has to be physically present to bill advance care planning (ACP), CMS wrote, “As indicated in the CPT code descriptors, CPT codes 99497 and 99498 can only be reported for time spent with the beneficiary, family members, and/or surrogate. If the beneficiary is not present, you should document that the beneficiary is impaired and unable to participate effectively and that ACP was instead conducted face-to-face with family or other legal surrogate(s).”
In addition to that guidance, CMS also recently alerted the National Hospice and Palliative Care Organization that nothing restricts Part A hospice claims “from including line items and being reimbursed for ACP services performed by attending physicians that work for, or under arrangement with, the hospice (CPT codes 99497, 99498).”