CMS proposed rule would reimburse physicians for care planning conversations

Categories: Policy.

The Centers for Medicare and Medicaid Services has released the Medicare Physician Fee Schedule proposed rule that makes the two advance care planning codes established in FY2015 “active” and begins the process of allowing physicians to code and be paid for advance care planning discussions they have with their patients. 

The National Hospice and Palliative Care Organization enthusiastically supports this new proposed rule, and plans to comment on the great value of having these important and complicated conversations with Medicare beneficiaries. 

In the CY2015 final rule, published late in 2014, the CPT Editorial Panel established two 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.  However, in the CY2015 final rule, reimbursement was not attached. 

With the release of this proposed rule, CMS is indicating that the establishment of payment rates for advance care planning conversations between physicians and patients can begin as early as January 1, 2016 and that physicians  will receive payment for these important physician-patient conversations around advance directives and discussions around patient goals of 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 has state-specific advance directive forms and information on advance care planning that can be downloaded from the website Each state’s advance directive is legally reviewed on an annual basis and meets each state’s statutory requirements.

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