Physician Reimbursement for End of Life Planning

The Centers for Medicare and Medicaid Services released a proposed regulation, as part of the proposed Medicare Physician Fee Schedule rule, that allows doctors to be reimbursed for end of life planning with patients. These counselling sessions, known as advance care planning, allows a doctor to bill for two 30 minute sessions with a patient to discuss how they would like to be treated as they are dying.

For physicians billing Medicare for reimbursement, this will make two new codes active. Although the codes were enacted in the fiscal year 2015 fee schedule, they were not eligible for reimbursement. The new fee schedule, that would be effective January 1, 2016, allows physicians to be reimbursed for two 30 minute sessions. Although experts expect that many patients will only require one 30 minute session, up to an hour can be reimbursed.

For the approximately 55 million individuals insured by Medicare, this will allow the patient to tell the doctor what their wishes are and how they would like to be cared for at the end of life. Although some private insurers currently offer payment for these discussions, Medicare offering reimbursement will significantly increase the volume of these discussions. The proposal will be open to comment for 60 days, prior to the final rule being published at the end of 2015, with reimbursement starting on January 1, 2016.

© 2015 Houghton Vandenack Williams

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