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.