End-of-Life Discussion Codes Sign Medicare will Consider Reimbursement

patient consulting with doctorThe American Medical Association (AMA) has released new current procedural terminology (CPT) codes that are to be used in advanced care planning services. This is a necessary step for Medicare to start considering reimbursement for the end-of-life discussions that physicians have with their patients.

The codes are designed to streamline private payer reimbursement.

One of the billing codes applies to the first 30 minutes of time a physician spends with a patient, a family member, or a surrogate to explain advance directives. There is an additional code provided for each additional 30 minutes of discussion and planning.

The new billing codes were released at the end of August 2014 and will go into effect in January.

One official said that the implementation of these new CPT codes have to do with the acknowledgement that end-of-life discussion is something that is important. Such conversations are not just patient-centered, but they are also person-centered.

Although patients have diagnoses, they also have emotions and fears. They even have spiritual needs. Physicians are able to treat both the person and the patient by having discussions that determine their goals and needs.

Research has shown that patients and their families prefer these types of conversations. It gives the patients the opportunity to think about what they would want in different cases.

When a patient is able to think about what they want when the time comes, the medical team has a better understanding of what they want and can focus their care around those wants. Family members can also focus on giving their ailing family members the love that they need rather than wondering about what needs to happen next.


Although doctors typically agree regarding the need for end-of-life discussions, the decision to reimburse for end-of-life conversations has yet to be made by Medicare. Just because a CPT code exists doesn’t mean that Medicare reimbursement is going to happen. This is a decision that is expected to be made in November.

When it is formulated properly, Medicare payment policies should be based on a full understanding of the resources and the time that is involved when physicians take care of their patients. This is why the American Medical Association (AMA) and the different medical societies have the Relative Value Scale Update Committee (RUC). This committee is an important source of input when it comes to Medicare deciding on the work, time, and resources that are needed to provide patients with the safest and highest quality care of patients.

So does lack of reimbursement mean that physicians should not have these end-of-life talks with their patients? Of course it doesn’t. These are conversations that are important to patients as they are ending the end of their lives. Doctors are having them anyway, but, because of the time and effort involved, reimbursement is something that can help a physician’s bottom line a great deal.

It is believed that these new CPT codes are a step in the right direction. The code would allow physicians to conduct these conversations more in a way that coincides with the wants and needs of the patient while billing for them. And, just like all codes, they have to be billed correctly in order to be effective. Billing code errors cost practices, so it is very important to be up-to-date on the latest codes and ensure that systems in place are prepared to receive and implement them.

Approval for the Concept

The fact that the codes have been created shows that there is approval among the ranks for the concept of billing for these conversations. Reimbursement for these end-of-life codes could be the difference between a patient having the conversation that they want and not having what they feel that they need. Patients want their doctors to care.

Any time it comes to implementing new billing codes or a new methodology to doing things, consultants are an ideal way to seamlessly integrate new codes and procedures. It is important to ensure the coding is applied correctly, as, in this case, time dictates everything. For instance, the code covers 30 minutes of conversation. In many cases, individuals don’t even spend a total of 30 minutes with their physician and that includes evaluation and conversation. If physicians are able to be reimbursed for their time, the time spent with patients can be greater.


Any time you need to implement new coding, it is important that you ensure all procedures are sound and MD Pro Solutions can help. Call us at 508-946-1665 or fill out our contact form to schedule a free consultation.