The ATS is pleased that CMS has finally agreed to reimburse physicians for discussing advance care planning with Medicare beneficiaries. The ATS has long advocated for CMS to recognize the value of and pay for this important service. Prior to January 2016, neither physicians nor beneficiaries could seek reimbursement from Medicare for advance care planning, if those discussions were the sole purpose of the visit. ATS as part of 66 organizations representing patients, healthcare professionals, caregivers, and many other stakeholders endorsed a letter asking Secretary of Health and Human Services Sylvia Mathews Burwell to recognize Advance Care Planning (ACP) as an essential element of high-quality care that supports patients in aligning their future care with what is most important to them through ongoing conversations with their healthcare professionals. ACP leads to better care, higher patient and family satisfaction, fewer unwanted hospitalizations, and lower rates of caregiver distress, depression, and lost productivity, according to recent studies. The 2004 IOM report, “Dying in America,” also cited payment for ACP as one five key recommendations for improving care quality and honoring individual wishes and expectations.
As a result of the stakeholder efforts, the Centers for Medicare and Medicaid Services (CMS) will begin covering ACP— discussions that physicians and other health professionals have with their patients regarding end-of-life care and patient preferences—as a separate and billable service. The following FAQs provide information on Medicare’s policies in end-oflife care and advance care planning.
Status N description, Items and Services Packaged into APC Rates Paid under OPPS; payment is packaged into payment for other services. Therefore there is no separate APC payment.
Status Q1 description, STV-Packaged Codes
Paid under OPPS; Addendum B displays APC assignments when services are separately payable.
- Packaged APC payment if billed on the same date of service as a HCPCS code assigned status indicator “S,” “T,” or “V.”
- In other circumstances, payment is made through a separate APC payment.
