PALLIATIVECARECOVERAGEAND CONSIDERATIONS

The Medicare Benefit Policy Manual describes coverage for the services of Nurse Practitioners in Chapter 15 ? Covered Medical and Other Health Services: http://www.cms.gov/Regulations-andGuidance/Guidance/Manuals/Downloads/bp102c15.pdf

200 - Nurse Pract it ioner (NP) Services (Rev. 11771 ; Issued:12-30-22 ; Effective:01-01-23 ; Implementation:01-01-23 ) ?

B Coverage is limited to the services an NPis legally authorized to perform in accordance with State law (or State regulatory mechanism established by State law)

2 Services Otherwise Excluded From Coverage The NPservices may not be covered if they are otherwise excluded from coverage even though an NPmay be authorized by State law to perform them For example, the Medicare law excludes from coverage routine foot care, routine physical checkups, and services that are not reasonable and necessary for the diagnosis or treatment of an illness or injury or to improve the functioning of a malformed body member Therefore, these services are precluded from coverage even though they may be within an NP?s scope of practice under State law ?

Advance Care Planning

In 2015, AMA created two new CPT® codes (99497 and 99498) for counseling patients on advance care planning, which is frequently a component of palliative care Medicare covers these services for both professionals and facilities:

99497 - Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; first 30 minutes, face-toface with the patient, family member(s), and/or surrogate

99498 - Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; each additional 30 minutes (list separately in addition to code for primary procedure)

Medicare reimbursement rates are available in the PARA Data Editor:

Care Managem ent Program s

Medicare also covers several different types of care management programs to assist providers in meeting the needs of seriously ill Medicare beneficiaries. A link and a screenshot of the Medicare website that summarizes those programs is provided below: https://www cms gov/Medicare/Medicare-Fee-for-ServicePayment/ PhysicianFeeSched/Care-Management