Palliative Care Billing Services
There is no single code for palliative care. A palliative visit is built from evaluation and management codes, advance care planning codes, and sometimes care coordination codes, and each piece has its own documentation and time rules. The most common billing failure in this specialty is not a wrong code but a missing one: advance care planning conversations that were never billed because the time was not documented, or symptom management visits that were downcoded because the note did not support the level billed.
MedPlus RCM provides medical billing, coding, credentialing, and denial management for palliative care practices, built around the specialty’s actual code families and payer requirements.
Palliative Care billing challenges
Advance care planning, or ACP, is the most distinctive billing element in palliative care. Code 99497 covers the first 30 minutes of a face-to-face advance care planning discussion with the patient, family members, or a surrogate, and code 99498 is an add-on for each additional 30 minutes. Because these are time-based codes, 99497 becomes billable once 16 minutes of planning discussion are documented, with 16 to 45 minutes supporting 99497 alone and 46 to 75 minutes supporting 99497 plus one unit of 99498. The documentation must record the content of the discussion, the voluntary nature of the encounter, who participated, and the time spent. No specific diagnosis is required, and completing a formal advance directive form is not required for the service to be billable.
ACP also interacts with wellness visits. When advance care planning is delivered on the same day as a covered Medicare wellness visit, by the same provider, and billed with modifier 33, Medicare waives the coinsurance and the Part B deductible for the planning service. If the wellness visit itself is denied, the planning service can still be paid as a separate medically necessary service, though cost-sharing then applies. For patients enrolled in hospice, billing rules differ: planning services by clinicians employed by or under arrangement with the hospice are billed through the hospice, while independent clinicians bill under Part B, so the employment relationship must be checked before the claim goes out.
The rest of palliative billing is evaluation and management, and it must be coded on its own merits. Symptom management visits, family meetings, and goals-of-care discussions that are not advance care planning are billed with office, hospital, or nursing facility visit codes based on medical decision making or time. Transitional care management codes 99495 and 99496 apply where their requirements are met, for example after a hospital discharge with interactive contact and a timely face-to-face visit. Palliative care differs from hospice in billing as well as in care: palliative care can be delivered alongside curative treatment, while hospice is a separate benefit with its own election and billing structure, and confusing the two on a claim creates denials.
What MedPlus RCM handles for Palliative Care practices
- End-to-end medical billing. Charge entry, claim scrubbing, submission, payment posting, and patient billing, the full cycle.
- Medical coding. Certified coders assign current ICD-10, CPT, and HCPCS codes matched to your documentation and specialty.
- Provider credentialing and enrollment. End-to-end enrollment with commercial payers and Medicare, plus re-credentialing maintenance.
- Denial management and recovery. Every denial investigated to root cause, corrected, and appealed with documentation.
- A/R recovery. Aged and outstanding balances audited and pursued, including balances already written off where the appeal window is still open.
- Financial reporting. Clean claim rates, collections, denial patterns, and A/R aging visible by payer and provider.
We serve palliative care practices nationwide, including outpatient clinics, hospital consult services, home-based programs, and hospice-affiliated palliative teams.
Results Palliative Care practices can check
MedPlus RCM maintains a 99% clean claim rate and keeps client accounts receivable under 30 days. Pricing is a performance-based percentage of successfully collected revenue: if you don’t get paid, we don’t get paid. We are 100% HIPAA compliant, and onboarding takes 2 to 4 weeks depending on practice size, with no disruption to your daily cash flow.
Frequently asked questions
Is there a CPT code for palliative care itself?
No. Palliative care is billed with evaluation and management codes, advance care planning codes 99497 and 99498, and care coordination codes where their requirements are met.
How much time is needed to bill advance care planning?
Code 99497 becomes billable at 16 minutes of documented planning discussion, covering 16 to 45 minutes. Each additional 30 minutes is billed with add-on code 99498.
Does the patient need a terminal diagnosis for advance care planning?
No. Advance care planning does not require a specific diagnosis, and completing a formal advance directive form is not required for the service to be billable.
Can advance care planning be billed with other visits?
Yes, when the planning discussion is distinct and its time is documented separately. When it is delivered with a covered Medicare wellness visit and billed with modifier 33, Medicare waives cost-sharing for the planning service.
What does MedPlus RCM charge?
A performance-based percentage of successfully collected revenue. If you don’t get paid, we don’t get paid.
Get a free financial audit
Find out where your palliative care practice is losing revenue. Request a free financial audit and our specialists will review your claims, denials, and A/R.
