Is advance care planning required at every Medicare patient visit?

This resource is part of the AMA's Debunking Regulatory Myths series, supporting AMA's practice transformation efforts to provide physicians and their care teams with resources to reduce guesswork and administrative burdens.

Debunking the myth

Advance care planning (ACP) is not required to be addressed at every Medicare patient visit. Medicare does not place any frequency-related requirements or restrictions on addressing ACP due to the variability in need for the service among patients. For instance, patients who are very ill or have experienced changes in their health status may need to have ACP conversations multiple times a year, while less frequent conversations may be adequate for others.

Background

Advance care planning is a billable, face-to-face service between a physician (or nurse practitioner, physician assistant, or clinical nurse specialist) and a patient and/or surrogate (e.g., health care agent, designated decisionmaker, family member, or caregiver) to discuss and make known the patient’s health care wishes in case the patient becomes unable to make health care decisions for themselves.¹  

Advance care planning includes, but is not limited to, education, discussion, completion, and review of advance directives. Common advance directives are the living will and durable power of attorney for health care.² ACP performed during a Medicare Annual Wellness Visit (AWV) is considered a component of the AWV and is not separately reimbursed; however, when performed separately from an AWV it is reimbursable as a medically necessary service. When ACP services are performed and billed, documentation of a change in the patient’s health status and/or their wishes about end-of-life care is required.¹

AMA policy

• 5.1 Advance Care Planning
• Encouraging the Use of Advance Directives and Health Care Powers of Attorney H-140.845
• Timely Promotion and Assistance in Advance Care Planning and Advance Directives D-140.953
• Educating Physicians About Advance Care Planning H-85.956
• Payment for Patient Counseling Regarding Advance Care Planning H-390.916
• Advance Directives During Pregnancy H-85.952
• Use of Psychiatric Advance Directives H-140.826

Resources

• CMS Billing and Planning- Advance Care Planning Article A58664
• CMS March 2024 Advance Care Planning MLN Booklet (PDF)
• AMA Advance Directives Article
• Download this myth: Advance care planning at Medicare visits (PDF)

References

1. Centers for Medicare & Medicaid Services. Billing and Coding: Advance Care Planning (A58664).; 2021. Accessed February 19, 2024. https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=58664
2. National Institute on Aging. Advance Care Planning: Advance Directives for Health Care. National Institute on Aging. Published October 31, 2022. Accessed February 19, 2024. https://www.nia.nih.gov/health/advance-care-planning/advance-care-planning-advance-directives-health-care

​​​​​​Debunking Regulatory Myths overview

Visit the overview page for information on additional myths.

Disclaimer: The AMA's Debunking Regulatory Myths (DRM) series is intended to convey general information only, based on guidance issued by applicable regulatory agencies, and not to provide legal advice or opinions. The contents within DRM should not be construed as, and should not be relied upon for, legal advice in any particular circumstance or fact situation. An attorney should be contacted for advice on specific legal issues. Additionally, all applicable laws and accreditation standards should be considered when applying information to your own practice.