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June 01, 2015

Centers for Medicare and Medicaid Services May Finally Pay for Advance Care Planning

(The pdf for the issue in which this article appears is available for download: (Bifocal, Vol. 36, Issue 5).)


On July 8, 2015, Centers for Medicare and Medicaid Services (CMS) announced its proposed physician fee schedule for next year. Two new Advance Care Planning codes that had been recommended by the American Medical Association are included and are funded. Both codes apply to a physician or other qualified health professional providing advance care planning services. If included in the final rule, this will be the first time advance care planning counseling will be expressly reimbursable by Medicare (other than as part of the Welcome to Medicare exam).

The comment period on the rule runs till September 8, 2015. When coverage of advance care planning was proposed as part of the Affordable Care Act, it triggered a hyperbolic “death panel” backlash. The proposed rule will need overwhelming support to survive, so supportive comments from as many groups as possible is extremely important.

The pre-publication copy of the rule is at: Instructions on filing comments are included. The advance care planning language in the rule is on pp. 246-247.

The ABA has strong policy in favor of advance care planning. Health care providers can’t know and honor patient’s values and wishes unless these care planning conversations take place. All the incentives in Medicare right now work against focusing time on meaningful care planning discussions. These proposed codes are long overdue and will have the effect of acknowledging the importance of those conversations and providing at least a modicum of incentive to engage in them.

Related Commission-supported policy is online at:

Advanced Care, February 2015, 100
Urges federal, state, local, territorial, and tribal governments to enact legislation and regulation that will promote six enumerated components in the provision of care to persons with advanced illness.

Medical Decision-Making, August 2012, 106A
Amendments to the Patient Self Determination Act, calling for strengthening advance care planning rights and procedures for health care decisions. ■