Advance care planning at Medicare visits

Must advance care planning be addressed at every Medicare visit?

Debunking Regulatory Myths-series only

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.



Advance care planning (ACP) must be addressed at every Medicare patient visit.

Advance care planning regulatory myth

Must advance care planning be addressed at every Medicare visit?

Advance care planning 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.

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

Reducing Regulatory Burden Playbook

Avoid overinterpreting the rules! This AMA STEPS Forward® playbook is your roadmap to practice efficiency.

  1. Centers for Medicare & Medicaid Services. Billing and Coding: Advance Care Planning (A58664).; 2021. Accessed February 19, 2024.
  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.

Visit the overview page for information on additional myths.

Submit your regulatory myth

AMA seeks to aid physicians and care teams by helping them understand medical regulatory requirements. Help us help you—submit a myth you'd like clarification on.

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.