Advance Care Planning conversations and completion of advance directives are reimbursable by Medicare.  Other payers frequently adopt Medicare billing and payment rules, but they are not required to do so.  Providers of patients enrolled in a Medicare Advantage plan or other payers will have to check directly with the health plan carrier to determine if the Medicare codes are payable by the carrier.

Cost to patients.  All Medicare beneficiaries are entitled to an annual wellness visit (AWV) which does not have any cost-sharing liability for the beneficiary.  If the ACP discussion is part of the AWV, there is no Part B coinsurance or deductible payment. Since ACP services are voluntary, when a beneficiary (or family members and/or surrogate) elects to receive ACP outside the AWV, CMS encourages practitioners to notify patients that Part B cost sharing will apply as it does for other physicians’ services.  Clinicians should communicate with their organization’s billing office for billing specifics.

CLICK ON THE LINKS BELOW FOR MEDICARE INFORMATION AND RESOURCES:

• Medicare codes for ACP Conversations - Bill Dunbar and Associates (pdf)
• Putnam County Hospital Annual Wellness Visit Toolkit 2023 (pdf)
• Centers for Medicare and Medicaid Services (CMS) – Advance Care Planning Fact Sheet
• CMS clarifies advance care planning coding and billing requirements – American Academy of Family Physicians (AAFP)
• Advance Care Planning: Discussion Guide and Visit Documentation Form – AMDA
• End of Life Care Conversations: Medicare Reimbursement FAQs – Conversation Ready (pdf)
• FAQs – Advance Care Planning Under Medicare – Coalition for Compassionate Care (pdf)