Advance Care Planning Covered By Medicare

Medicare and Medicaid introduced two new billing codes January 1, 2016, that allow physicians and other qualified health care professionals (including nurse practitioners) to bill for providing advance care consultation and planning to patients. Medicare includes advance care planning as an optional element of the annual wellness visit (AWV), and services furnished on the same day and by the same provider as an AWV are considered a preventive service. If the patient chooses to have this service in conjunction with an AWV, he or she will not have any cost-sharing liability (though the physician can bill Medicare for both the AWV and advance care discussion separately). Medicare will cover advance care planning provided in medical offices and facility settings, including hospitals, with or without completing relevant legal forms.

The advance care planning benefit is open to anyone with Medicare and a person does not have to have a terminal illness to take advantage of this benefit. In fact, it is better to discuss end-of-life care before a person is diagnosed with a life-threatening condition, when there is plenty of time to consider one’s preferences.

Because Medicare often sets the standard for private insurers as well, in time more private health insurance companies are likely to adopt the same rules.