S.2865 (Improving Access to Advance Care Planning Act) adds a statutory definition of “advance care planning services,” lists eligible practitioners, authorizes Medicare payment for those services, removes geographic telehealth limits for delivering them, and directs HHS outreach and a MedPAC study. The bill also eliminates beneficiary cost-sharing and Part B deductible for advance care planning services beginning January 1, 2027.
This matters to providers who bill Medicare (physicians, PAs, NPs, clinical social workers, and others the Secretary approves), revenue-cycle and compliance teams who will update coding and claims rules, and Medicare beneficiaries and their families who stand to get more affordable access to documented care preferences. The measure changes payment incentives, telehealth billing rules specific to these codes, and creates new administrative work for CMS and for clinicians seeking to bill appropriately.
At a Glance
What It Does
The bill adds a new definition for advance care planning services to section 1861 of the Social Security Act, requires CMS to make payments under the physician fee schedule for those services, and amends Part B to waive beneficiary cost-sharing and deductible for such services starting January 1, 2027. It also exempts these telehealth visits from Medicare’s usual geographic restrictions and mandates HHS outreach and a MedPAC study and report.
Who It Affects
Directly affected parties include Medicare Part B beneficiaries, clinicians eligible to furnish and bill advance care planning (physicians, physician assistants, nurse practitioners, clinical nurse specialists, clinical social workers meeting certification/experience standards, and others the Secretary designates), CMS and its contractors, and health system billing/compliance teams that process HCPCS/CPT codes 99497 and 99498 (and successors).
Why It Matters
The bill removes a significant financial barrier to advance care planning by eliminating cost-sharing and by legitimizing telehealth delivery regardless of patient location, which could increase uptake. At the same time it creates new coding, training, and oversight tasks for CMS and providers and creates budgetary exposure for Medicare’s Part B payment pool.
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What This Bill Actually Does
S.2865 inserts a single, statutory definition of advance care planning into Medicare law and links payment and telehealth rules to that definition. The new definition covers conversations with the beneficiary, family, caregivers, or representatives about health-care preferences, future decisions, and completion of advance directives or standard forms.
It also spells out who may be paid: physicians, physician assistants, nurse practitioners, clinical nurse specialists, clinical social workers who meet a certification or experience standard set by the Secretary, and any other practitioner the Secretary deems appropriate.
On payment, the bill directs CMS to make payments under the physician fee schedule for advance care planning services, subject to three administrative guards: payment to only one applicable provider for a beneficiary “during a period,” prohibition on duplicative payments under other Medicare provisions, and an explicit bar on requiring an annual wellness visit or initial preventive exam as a precondition for payment. The legislative text points to existing HCPCS codes 99497 and 99498 (or successors) in the outreach provision and instructs CMS to educate providers about billing and beneficiary eligibility.The bill eliminates beneficiary cost-sharing and the Part B deductible for advance care planning services furnished on or after January 1, 2027, by amending section 1833.
It specifies that Medicare will pay 100 percent of the lesser of the actual charge or the fee schedule amount for these services, effectively making them free at the point of care for Part B enrollees after that date. Separately, the statute amends federal telehealth law to exempt advance care planning from Medicare’s geographic originating-site restrictions, enabling these visits via telehealth regardless of the patient’s location under the conditions set for telehealth visits.Implementation tasks in the bill include a one-time HHS outreach and education initiative for physicians and appropriate non-physician practitioners about the new coverage and coding (explicitly referencing HCPCS 99497 and 99498), plus reporting to relevant congressional committees on outreach methods.
The bill also requires MedPAC to study who furnishes advance care planning, billing patterns (including when providers use non-ACP CPT codes), visit length and frequency, barriers to furnishing services, and to deliver a report with recommendations by June 30, 2027.
The Five Things You Need to Know
The bill adds a new subsection 1861(nnn) defining 'advance care planning services' and enumerating eligible practitioners, including physicians, PAs, NPs, clinical nurse specialists, clinical social workers with specified certification/experience, and others the Secretary designates.
CMS must make physician-fee-schedule payments for advance care planning services but may pay only one applicable provider for a beneficiary during a given 'period,' may not pay duplicative Medicare claims, and cannot condition payment on an annual wellness visit or initial preventive physical exam.
Section 1833 is amended to eliminate Part B beneficiary cost-sharing and the deductible for advance care planning services furnished on or after January 1, 2027, with payment equal to 100% of the lesser of actual charge or the Medicare-determined amount.
The bill removes Medicare’s geographic originating-site requirement for telehealth when the service furnished is advance care planning, allowing those ACP visits to be delivered by telehealth regardless of patient location.
HHS must conduct a one-time outreach and education effort for providers about ACP coverage (referencing HCPCS codes 99497 and 99498), and MedPAC must study ACP furnishing and coding practices and submit recommendations to Congress by June 30, 2027.
Section-by-Section Breakdown
Every bill we cover gets an analysis of its key sections.
Short title
Designates the Act as the 'Improving Access to Advance Care Planning Act.' This is purely a caption but signals congressional intent to treat advance care planning as an access and coverage priority, which can influence CMS communications and rulemaking emphasis.
Statutory definition and eligible practitioners
Adds subsection 1861(nnn) to define 'advance care planning services' and specifies which practitioners may furnish them for Medicare payment. The list includes physicians, physician assistants, nurse practitioners, clinical nurse specialists, and clinical social workers who meet a certification or experience standard to be set by the Secretary, with a catch‑all for other practitioners the Secretary approves. Practical implication: CMS will need to issue guidance on what counts as a qualifying certification or evidence of experience for social workers, and on any credentialing or documentation expectations for other non-physician providers who seek payment.
Fee-schedule payment rules and payment guards
Inserts a new paragraph into section 1848(b) directing CMS to pay for advance care planning under the physician fee schedule and specifying three administrative rules: pay only one applicable provider for a beneficiary during a 'period' (term of art left undefined), disallow duplicate payments under other Medicare authorities, and prohibit conditioning payment on an annual wellness visit or initial preventive exam. These rules will require CMS to define 'period' in claims processing guidance and to build edits that prevent duplicate payments or improper bundling, creating immediate work for contractors and payers.
Eliminate Part B deductible and coinsurance for ACP visits starting 2027
Amends section 1833 to specify that for advance care planning services furnished on or after January 1, 2027, the amount paid equals 100% of the lesser of actual charge or Medicare-determined amount and that the Part B deductible does not apply. Operationally, Medicare Administrative Contractors and claims systems must be updated to pay these claims without patient cost-sharing as of the effective date, and beneficiary communications should be prepared to explain the change in out-of-pocket liability.
Exempt ACP from telehealth geographic originating-site rules
Modifies the telehealth statute to exclude advance care planning from the usual geographic requirements in paragraph (4)(C)(i), meaning that ACP telehealth visits may be furnished regardless of the beneficiary’s location. The exemption removes one long-standing barrier to virtual ACP conversations, but other telehealth program rules (modality, documentation, technology standards) remain in effect and will govern how providers deliver remote ACP services.
HHS provider outreach and report
Requires HHS to conduct a comprehensive, one-time outreach and education initiative to inform physicians and appropriate non-physician practitioners about ACP coverage and billing — explicitly citing HCPCS codes 99497 and 99498 (or successors). HHS must then report to Senate Finance and House Ways & Means and Energy & Commerce Committees within one year after completing outreach, describing methods used. This creates a near-term administrative deliverable for CMS and a record for Congress to track implementation.
MedPAC study and report on ACP furnishing and coding
Directs the Medicare Payment Advisory Commission to study who furnishes ACP services, visit length/frequency, provider training, the use and misuse of ACP CPT codes (and circumstances where other codes are billed), barriers to provision and coding, and other items MedPAC deems appropriate. MedPAC must report findings and recommendations by June 30, 2027. The study is designed to inform any follow-up legislative or administrative fixes and to identify program integrity or training needs.
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Explore Healthcare in Codify Search →Who Benefits and Who Bears the Cost
Every bill creates winners and losers. Here's who stands to gain and who bears the cost.
Who Benefits
- Medicare Part B beneficiaries — They will have no coinsurance or deductible for advance care planning services furnished on or after January 1, 2027, removing an important cost barrier to documenting preferences and completing advance directives.
- Primary care clinicians and palliative care teams — The statutory definition and explicit fee-schedule payment signal stable reimbursement for time spent on ACP conversations, making it administratively easier to bill for and prioritize these visits.
- Non-physician practitioners (NPs, PAs, qualifying clinical social workers) — The bill explicitly recognizes these clinicians as eligible providers and authorizes payment, expanding their ability to be compensated for ACP work subject to any Secretary rules on social worker qualifications.
- Telehealth providers and rural patients — By lifting the geographic originating-site rule for ACP telehealth, the bill facilitates virtual conversations for beneficiaries who live in remote areas or who have mobility/transportation barriers.
Who Bears the Cost
- Medicare Part B trust fund — Eliminating beneficiary cost-sharing will increase Medicare payments for ACP services and shift more of the financial burden to federal Medicare funds, with consequent budgetary impact.
- CMS and Medicare Administrative Contractors — They must develop and deploy new coding edits, payment logic to enforce the 'single provider per period' rule, outreach materials, contractor instructions, and reporting mechanisms for the outreach and MedPAC deliverables.
- Health systems and billing/compliance teams — Organizations will need to update claims workflows, train clinicians on correct CPT/HCPCS usage, and prepare documentation standards to withstand audit and avoid duplication denials.
- Small practices and clinicians — While they may gain reimbursement, they will also face upfront administrative costs for training, documentation practices, and potential investments in telehealth technology or secure documentation workflows.
Key Issues
The Core Tension
The central tension is between making advance care planning widely accessible by removing financial and geographic barriers, and protecting Medicare’s program integrity, budgets, and the clinical quality of ACP encounters: incentivizing more conversations can improve patient-centered care but risks increased low-value billing, administrative complexity, and disputes over who may bill and when.
The bill leaves several implementation details to CMS and MedPAC that could materially affect how the policy works in practice. Key undefined terms — most notably what constitutes a 'period' for the statute’s single‑provider payment rule and the Secretary’s standards for clinical social worker certification or experience — will determine whether multiple clinicians on a care team can bill for distinct conversations or whether claims will be denied as duplicative.
Similarly, instructing CMS to pay 'as the Secretary determines appropriate' gives broad administrative discretion that could lead to significant variation in payment rates and documentation requirements.
Program-integrity and quality trade-offs are also unresolved. Removing cost-sharing will likely increase utilization, which can be a positive access outcome but also raises risks of short, transactional encounters billed primarily for payment rather than meaningful goals-of-care planning.
The prohibition on duplicative payments and the undefined 'period' create potential for claim disputes and denials, especially where a beneficiary has multiple conversations with different providers (primary care, specialist, social worker) over time. Finally, the change applies to fee-for-service Medicare under title XVIII; the bill does not amend Medicare Advantage statutes, so coordination between FFS and MA plan practices could cause coverage and billing confusion.
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