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  • PDCM Billing Codes
    • G9001: Comprehensive Assessment
    • G9002: Maintenance
    • 98966-98968: Telephonic
    • 99487, 99489: Care Coordination (without patient)
    • G9007: Team Conference
    • 98961, 98962: Group Education
    • G9008: Care Oversight
    • S0257: Counseling Regarding Advance Directives
    • PDCM Reference Materials
    • PDCM FAQs
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S0257: Counseling Regarding Advance Directives

Description: Counseling and discussion regarding advance directives or end-of-life care planning and decisions, with patient and/or surrogate

Delivery Method: Face-to-face, telephone, or via video

Who Can Bill? Licensed care-team member or physician/APP

Payer Billing Allowance Requirement
BCBSM/BCN/BCN Advantage Once per patient, per day, per practice

 

BCN/BCN MA -  PCMH Designated Primary Care Providers only.  Specialist not eligible at this time.  

 

Priority Health Reportable for all Priority Health products, but only payable for commercial and Medicare This code is not included within the incentive program
Medicaid (varies by HMO) No limit on number of services per patient per year; cannot bill if beneficiary is in hospice during the same period  

Billing opportunities and reimbursement may vary depending upon organization's specific payer value-based contracts. All services should be billed in accordance with CPT and Center for Medicare & Medicaid service guidelines.

MICMT does not have expertise related to the Centers for Medicare and Medicaid services coverage decisions related to billing. The information contained on this site comes from publicly available sources of CMS information. Any needed clarification should come from CMS or their representatives/contractors. 

Recommended Documentation

  • Date of service and mode of contact and duration (phone/video/face-to-face)
  • Name and credentials of person
  • Identify any other individual(s) in attendance and relationship to
  • Active diagnosis
  • Pertinent details related to discussion and resulting advance care plan decisions, minimally including:
    • Person designated to make decisions for patient, if applicable
    • Types of medical care preferred
    • Comfort level that is preferred
    • How patient prefers to be treated by others
    • What the patient wishes others to know
  • Indication if advance directive or Physician Orders for Life-Sustaining Treatment was or was not completed

S0257 (End-of-Life Counseling Advance Directive) FAQs.

For additional PDCM FAQs, please click here

Q: Can a care team member bill for advance care planning conversations?

A: Yes, care team members who conduct end-of-life (advance care planning) conversations with either the patient or “surrogate” can bill S0257.



Watch the Example Video


Reviewed and approved by Blue Cross Blue Shield of Michigan as of April 29, 2022.
Reviewed and approved by Priority Health as of November 7, 2021.
Michigan Institute for Care Management and Transformation
2500 Green Rd, Suite 100
Ann Arbor, MI 48105

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Disclaimer Statement: Although Blue Cross Blue Shield of Michigan and MICMT work collaboratively, the opinions, beliefs and viewpoints expressed by the author do not necessarily reflect the opinions, beliefs and viewpoints of BCBSM or any of its employees.

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