Hematology/oncology utilization of advance care planning services.

Abstract

25 Background: In 2016, Medicare added coverage for advance care planning (ACP) services (CPT codes 99497 and 99498). ASCO’s Coverage and Reimbursement Steering Group sought to explore and quantify whether these codes are regularly utilized by hematology and oncology physicians, and to provide guidance on administrative best practices for successful reimbursement. Methods: We analyzed utilization of care management services using Physician/Supplier Procedure Summary (2016-2019) and Medicare Provider Utilization and Payment Data: Physician and other Supplier PUF CY2018 (PUF) files, available on data.cms.gov. Data files are limited to lines representing services to at least 11 unique Medicare beneficiaries; otherwise, Medicare imputes a blank value. Total ACP services submitted to Medicare and the total services denied were calculated for each year using the combination of Hematology, Hematology/Oncology, and Medical Oncology (collectively Hematology/Oncology) specialties, as well as for all specialties. Within Hematology/Oncology, we also pulled physician-level data for 6,335 physicians who had billed Medicare for at least 500 office or hospital outpatient evaluation and management services in 2018. Totals for codes 99497 and 99498 were calculated per physician, providing a distribution of volume. Results: Specialty utilization of ACP services has increased each year, from 708,183 submitted services in 2016 to 2,043,767 in 2019. Hematology/Oncology utilization increased from 2016 to 2017, followed by declines in volume for 2018 and 2019. Among 6,355 hematology/oncology physicians submitting at least 500 office or hospital outpatient evaluation and management visits, 145 billed Medicare at least 11 ACP services in either a facility or non-facility setting. Advance Care Planning Services (99497 and 99498) billed to Medicare in 2016-2019. Conclusions: Though Advance Care Planning is an integral part of cancer care, the codes are not frequently reported to Medicare as a separate service. This may be due to lack of awareness or understanding of the codes, and uncertainty as to how to implement the services into the workflow of the practice. To increase utilization and ensure appropriate reporting of ACP, Oncologists and Oncology practices would benefit from coding and reporting education, and well as guidance on administrative processes to successfully manage ACP services. ASCO's Coverage and Reimbursement Steering Group has developed a practice administration and reimbursement guide for publication on asco.org.[Table: see text]