Having “The Talk” and Getting Paid to Do It

There’s no question that delivering news that a patient has a life-limiting condition never gets easy. Too often, conversations about end-of-life wishes are delayed until after this diagnosis, making them even more fraught.

On January 1, 2016, the Centers for Medicare and Medicaid Services (CMS) introduced two new CPT billing codes to physicians: 99497 and 99498. With these two numbers, CMS began reimbursing for advance care planning, giving physicians an opportunity to build time into their patient visits to start this conversation before a crisis hits.

In an advance care planning conversation, patients can discuss their goals, values, and fears with their physician. These feelings coupled with the patient’s preferences for life-sustaining interventions and end-of-life care can help guide future treatment. These conversations may also include creating a written advance care document or the appointment of a healthcare power of attorney.

Requirements for CPT Code 99497 

• Covers the first 30 minutes of a face-to-face advance care planning conversation with the patient, family member(s), and/or other surrogates.
• Must be provided by a physician or other qualified healthcare professional.
• Completion of an advance directive is not required by CMS, but it is helpful documentation for both the physician and family member.

Requirements for CPT Code 99498

• Covers each additional 30 minutes of face-to-face advance care planning conversations with the patient, family member(s), and/or other surrogates.
• Must be provided by a physician or other qualified healthcare professional.
• It should be listed as a separately in addition to CPT Code 99497.

There is no specific diagnosis required and there are no limits on the number of times advance care planning can be reported. However, if the same patient is being billed for this conversation multiple times, there should be a documented change in their health status and/or wishes for end-of-life care. 

The time spent with patients on advance care planning engages them in the process of planning for their current and future care. It is a critical component in patient self-determination and ensuring end-of-life wishes are met. The CMS reimbursement ensures physicians are able to take the time necessary to have the advance care planning conversation patients want and need. 

Crossroads Hospice & Palliative Care is your partner in providing support to patients with life-limiting illnesses. Please call 1-888-563-3405 to learn more about hospice and how we can help.

Recommended Reading:

Approaching the Hospice Conversation: Best Practices for Physicians

Now It Pays to Talk About Death: Advance Care Planning

VIDEO: Having the Hospice Conversation

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