June 23, 2016
Area(s) of Interest: End of Life Issues Payor Issues and Reimbursement Practice Management
In another significant step toward normalizing and supporting advance care planning conversations, Medi-Cal is following Medicare’s lead by allowing providers to bill for advanced care planning discussions with beneficiaries.
The Centers for Medicare and Medicaid Services (CMS) began reimbursing codes 99497 and 99498 on January 1, 2016, but it was left up to state Medicaid programs (like California's Medi-Cal) to separately determine whether they would follow suit.
The California Medical Association (CMA) is a member of the Coalition for Compassionate Care Coalition of California, which wrote a letter to the California Department of Health Care Services in March urging the state to “follow the federal government’s lead and take the next logical step – reimburse Medi-Cal providers for advance care planning discussions.”
Specific guidance on use of the advance care planning codes with Medi-Cal beneficiaries has not yet been provided.
These are time-based codes: 99497 is for the first 30 minutes, and 99498 is an add-on code for each additional 30 minutes. Current Medi-Cal reimbursement rates for these codes are:
- 99497: $69.59
- 99498: $62.64
CMA will share additional details as they become available.