Our palliative care program focuses on supporting the health care needs of our members and their families at any stage of life or health status. We also want to support you in delivering quality care that honors your patients' wishes for treatment. As a community, we want to deliver individualized options to patients and ensure that our members' wishes have been documented and honored. Our services for members with serious or life-limiting illness allow for individualized care that could include home health aides, in-home counseling and easy access to help by phone. In addition, our Personalized Care Support program offers services for members with serious illness through specialized care management.
The palliative care benefit is embedded in most of our standard medical products. Verify your patients' eligibility and benefits using the Availity Provider Portal.
Note: Blue Cross and Blue Shield Federal Employee Program® (BCBS FEP®) plans' benefits for palliative care differ from all other Regence plans. Please refer to the Blue Cross Blue Shield Service Benefit Plan brochure for more information.
Goals of care conversation reimbursement
Providers can submit claims for advance care planning (ACP) services in addition to any evaluation and management (E&M) visit codes with the appropriate modifier and revenue code:
- CPT 99497 Advance Care Planning, face-to-face with patient, family member(s) and/or surrogate (first 30 minutes)
- CPT 99498 Advance Care Planning, face-to-face with patient, family member(s) and/or surrogate (additional 30 minutes)
In addition, providers can submit claims for telehealth ACP services using the codes above with modifier GT.
Skilled nursing facilities, home health agencies and hospice facilities should use revenue code 0691 pre-hospice/charge with the CPT codes referenced above.
Important reminders about ACP conversations
ACP conversations are valuable for patients at any age and health status.
- The Conversation Project offers free resources anyone can view, download and print.
- ACP conversations are a process occurring over a period of weeks, months or years. Providers are not required to have one conversation that covers multiple topics and documents in a single visit.
- Having ACP conversations lets patients know their wishes will be honored, so they can focus on their health and what matters to them. The conversations do not need to be depressing!
- The benefit allows for unlimited ACP encounters and during any provider appointment, up to once per day. ACP can be the sole reason for the visit, or a conversation can occur during any office visit for other treatments. This is not "double-dipping."
- ACP conversations are not role-specific. We reimburse any provider who bills CPT 99497 and 99498 in addition to other services during the patient's visit. (Our provider credentialing requirements must be met, and incident-to billing procedures must be followed.)
Palliative care home health and psycho-social benefit
Our palliative care benefit also covers in-home health and psycho-social visits provided to our members who are using the palliative care benefit. Home health agencies can submit claims using the following codes, along with the appropriate supplementary codes:
- CPT 99509 Home Visit for Assistance with Activities of Daily Living (ADLs) and Personal Care
- CPT 99510 Home Visit for Individual, Family, or Marriage Counseling
Medicare Advantage members are entitled to unlimited home health visits; commercial products that include the benefit cover up to 30 visits per year in any combination of these codes.
Members who are using the palliative care benefit are not required to be homebound to use home health services. The notification process through our Physical Medicine program is waived for palliative physical, occupational and speech therapies, as well as palliative massage therapies and chiropractic and acupuncture treatments.
Specialized care management
In addition to our home health and psycho-social coverage, our Personalized Care Support program includes specialized care management services and care coordination for group, Individual and Medicare Advantage members with serious illness and their families. These services are offered at no additional cost to our members and provide easy access to one-on-one support for when members face a serious or life-limiting illness.
Our nurse clinicians and social workers on staff have clinical expertise in advance care planning, serious illness management and end-of-life care for adults and children. Case managers can also help members and their caregivers understand benefits and connect them to community resources, such as meal delivery and transportation.
For our Medicare Advantage members
Medicare Advantage members are eligible for additional palliative care benefits, including medical team conferences and care coordination with no lifetime limit. Submit claims for professional services provided to our Medicare Advantage members using any combination of the following CPT codes in conjunction with CPT 1150F – Documentation that a patient has a substantial risk of death within one year.
Medical team conferences
- CPT 99366 Medical team conferences, direct face-to-face contact with patient and family
- CPT 99367 Medical team conferences, without direct face-to-face contact with patient and family
Supervision in a facility or home health setting
- CPT 99374, 99375, 99379, 99380 Care plan oversight services
Psychotherapy with patient and/or family
- CPT 90832, 90834 Psychotherapy
Patient home visits
- CPT 99341–99345 New patient, home visit
- CPT 99347–99350 Established patient, home visit