Policy No: 136
Originally Created: 01/01/2019
Last Reviewed: 12/01/2022
Last Revised: 12/01/2022
This policy applies only to physicians, facilities and other qualified health care professionals.
Specialized medical care for people with serious illness. This type of care is focused on providing relief from the symptoms and stress of a serious illness. The goal is to improve quality of life for both the patient and the family. Regence considers palliative care appropriate for a wide variety of diagnoses, chronic pain alone does not qualify a member for palliative care.
Palliative care services are specialized medical care for people living with serious illness who may have more focused medical goals depending on their prognosis. Care is focused on providing patients with relief from symptoms, pain and stress of a serious illness regardless of the prognosis. The individual providers that can provide palliative care can include but are not limited to:
- APRNs - Includes Clinical Nurse Specialists (CNSs) and Nurse Practitioners (NPs), depending on state regulations on scope of practice
- Physician Assistant
Acceptable CPT/HCPCS/Rev Codes for facilities:
- 99509 and revenue code 0691 — Pre-hospice/Charge Home Visit for assistance with Activities of Daily Living and Personal Care
99510 and revenue code 0691 — Pre-hospice/Charge Home Visit for Individual, Family, or Marriage Counseling.
Acceptable CPT/HCPCS Codes for professionals:
99497 and 99498 can still be billed as palliative care and will be subject to general medical benefits.
Centers for Medicare & Medicaid Services (CMS), 2016. 'Incident To' Services. MLN Matters Number: SE0441.
Centers for Medicare & Medicaid Services (CMS), 2017. Medicare Benefit Policy Manual, Chapter 15 – Covered Medical and Other Health Services. Section 60.4 – Services Incident to a Physician's Service to Homebound Patients Under General Physician Supervision.
Noridian Healthcare Solutions, 2017. 'Incident To' Services
Palmetto GBA, 2021. 'Incident To' and Split/Shared Services Frequently Asked Questions
Claims and Payment; Claims Submission
Center to Advanced Palliative Care — CAPC