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April 2, 2019

April 16th is National Healthcare Decisions Day

In recognition of National Healthcare Decisions Day, we would like to remind you that Medicare covers voluntary Advance Care Planning (ACP). Voluntary ACP is a face-to-face service between a physician (or other qualified health care professional) and a patient discussing advance directives with or without completing relevant legal forms. Medicare pays for ACP as a separate Part B medically necessary service or as an optional element of a patient's Annual Wellness Visit (AWV).

  • When the same provider furnishes ACP services on the same day as an AWV, Medicare waives the deductible and coinsurance for beneficiaries.
    • Providers will append Modifier 33 on the ACP.
  • When an AWV is medically necessary and billed with ACP, but Medicare denies the AWV for exceeding the once-per-year limit, Medicare can still pay for the ACP, but deductible and coinsurance applies to the ACP service.
  • When the practitioner provides ACP outside the covered AWV, deductible and coinsurance applies.

The National Healthcare Decisions Day (NHDD) mission states: NHDD exists to inspire, educate and empower the public and providers about the importance of advance care planning. NHDD is an initiative to encourage patients to express their wishes regarding healthcare and for providers and facilities to respect those wishes, whatever they may be. To learn more about the movement and ways to implement activities in your community and at your facility, visit the NHDD websiteExternal Website.

References:

This document was developed through the A/B Medicare Administrative Contractor (MAC) Provider Outreach & Education (POE) Collaboration Team. This joint effort ensures consistent communication and education throughout the nation on a variety of topics and will assist the provider and physician community with information necessary to submit claims appropriately and receive proper payment in a timely manner.

Source: POE A/B MAC Collaboration Team

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