Posted on: October 31, 2015
Written by: Coalition for Compassionate Care of California
NOTE: While we make every effort to ensure our information is accurate, staff at the Coalition for Compassionate Care of California are not Medicare billing experts. If you have detailed questions please consult with your own billing department.
On Oct. 30, 2015, the Centers for Medicare and Medicaid Services (CMS) released the final 2016 Medicare Physician Fee Schedule including two CPT codes to reimburse for advance care planning.
Reimbursement for advance care planning (ACP) is a game changer for Coalition for Compassionate Care of California supporters, bringing California one step closer to our goal of promoting high-quality, compassionate care for all Californians who are seriously ill.
The two ACP codes are:
- 99497 for an initial thirty minute voluntary advance care planning consultation (Final RVU 1.5)
- 99498 as an add-on code for additional thirty-minute time blocks needed (Final RVU-1.4)
While both codes were included in the CY 2015 proposal, they were designed as “inactive” and were not funded. In the proposed rule for CY 2016, these codes are designated as “active” and applicable for reimbursement. CMS will begin reimbursing for these consultations starting Jan. 1, 2016.
As the lead organization in California for advance care planning, including the Physician Orders for Life-Sustaining Treatment (POLST), CCCC appreciates that CMS has recognized the value and importance of advance care planning conversations between patients and healthcare professionals.
Read our letter in support of CPT codes CMS-1631-P here.
The final rule is more than 1,300 pages in length. To view the ACP payment code section, click here.
The full final rule can be downloaded here as a PDF.