CMS Considers Separate Payment for End-of-Life Discussions

The Centers for Medicare & Medicaid Services’ (CMS) proposed fee schedule for 2016, released July 8, includes a proposal to establish payment rates for 2 advance-care planning billing codes that would cover complex end-of-life discussions between Medicare patients and their providers. The CPT codes—99497 and 99498—were introduced last year but were not activated for payment.

“CMS did not make the new codes payable for 2015 in order to allow the public full opportunity to comment on whether Medicare should pay separately for these services and, if so, how much beginning January 1, 2016,” the agency explained in a fact sheet.

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When initially proposed in an early version of the Patient Protection and Affordable Care Act, separate payment for end-of-life discussions provoked controversy and “death panel” allegations from critics, and the provision was subsequently pulled from the legislation. When a later regulation proposing reimbursement for advance-care planning as part of an annual well visit again sparked criticism, the Obama administration withdrew that, too.

Currently, advance-care planning is only covered under the one-time Welcome to Medicare visit. CMS noted, however, that holding end-of-life discussions when patients first enroll in Medicare may not prove the most opportune time.

“Establishing separate payment for advance-care planning codes provides beneficiaries and practitioners greater opportunity and flexibility to utilize these planning sessions at the most appropriate time for patients and their families,” CMS wrote.

Organized medicine, AARP, and dozens of other patient and health care groups support Medicare reimbursement of advance-care planning, and in May wrote a letter urging the government to pay for the service beginning in 2016.

CMS is accepting public comments on its proposal through September 8, 2015.—Jolynn Tumolo

References

1. Lowes R. CMS proposes paying for end-of-life discussions. Medscape. July 8, 2015.
2. Proposed policy, payment, and quality provisions changes to the Medicare Physician Fee Schedule for Calendar Year 2016. Centers for Medicare & Medicaid Services. July 8, 2015.