Clinician use of advance care planning billing codes among privately insured patients in 2016

In January 2016, the Centers for Medicare and Medicaid Services launched two procedure codes that allow clinicians to bill for advance care planning (ACP).¹ In this study, we describe patterns of ACP code use by clinicians among their privately insured patients in 2016.

We performed a retrospective cohort analysis using the Optum^© Clinformatics^® Data Mart, which contains commercial and Medicare Advantage claims for 13.7 million members of a health insurer in the United States. We included patients with medical coverage in 2015 and 2016, and we identified clinicians billing for ACP based on claims containing code 99497 or 99498

Nationial Heart, Lung, and Blood Institute (NHLBI)