B-TAC

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ACP Billing Code Utilization Doubles from Prior Year

CMS data for the first half of calendar year 2017 shows that the Advance Care Planning (ACP) billing code utilization continues to rise and provide needed benefits to Medicare beneficiaries. This is the second year of data for these codes and it shows significant increases compared to the same period in 2016. 

For the January-June 2017 period, ACP bills were submitted for a total of 453,288 different Medicare beneficiaries. This represents just less than 1% of all Medicare beneficiaries and is up from only 0.4% the year before. Further findings:

  1. More providers are billing for these services and having them with more beneficiaries. The 23,509 providers filing claims in January-June 2017 is 70% higher than the 13,803 for the same period in 2016. The number of beneficiaries per provider also rose from 16.2 to 19.3.
  2. Some beneficiaries are having more than one ACP discussion. There were 9% more claims per beneficiary In Jan-June 2017 than the 6% in 2016 and the number of services was 13% vs. 9%.
  3. The amount of time for these services is holding steady at around 31 minutes. The latest data showed an average of 31 minutes vs. 30.8 minutes for the previous year.
  4. The rate of Medicare reimbursed dropped. Only 39% of the claims filed in January-June 2017 were reimbursed vs. 46% for the previous year. Per CMS, this difference represents growing patient co-pays and deductibles for these services.

January – June 2017 Claims vs January – June 2016 claims

Recommendations* Calculated using 2015 calendar year data for total Medicare beneficiaries as that is the latest available


  • The codes are still new and it takes time for new procedures and codes to become familiar to providers. It’s likely that many clinicians are still unware of them and so adoption will continue to take time. However, the field should be actively encouraging them as CMS does not continue billing codes indefinitely if they are not productive. C-TAC is working with its members and partners to increase awareness of these billing codes. Respecting Choices, now part of C-TAC Innovations, also provides ACP training as part of their work to transform health systems to provide more person-centered care.
  • The gap between the amount billed and paid out highlights that future policy should focus on reducing or eliminating copays and deductibles for these services. ACP conversations are already challenging for many and any barriers should be addressed. C-TAC champions legislation that aims to remove barriers to ACP conversations. Examples include the Patient Quality and Care Act, which removes ACP copays, and the Compassionate Care Act, which would actually provide a one-time payment of $75 to Medicare beneficiaries to participate in this process.

 

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