Palliative Care/Serious Illness Support is a comprehensive set of benefits and supports available to members and their caregivers who are living with serious illness. Our vision is that every person living with serious illness will experience personalized care that is consistent with their values, goals and preference; caregivers will feel included, honored and supported.
Our clinical team will help support providers who are looking for ways to better address the needs of their patients living with serious illness and who may benefit from specialty palliative care.
Our member benefit covers:
- Adult and pediatric palliative care case management: Assistance with care coordination and benefit navigation with nurses through telephonic support.
- Home health medical: Assistance with activities of daily living
- Psychosocial support: Through our expanded home health benefit, members are eligible to receive individual, family and marriage counseling in the home.
- Caregiver support: Our teams work with the member's and caregivers.
Goals of care/advance care planning (ACP) conversations: Provider reimbursement for conducting and documenting goals of care conversations with their Asuris patients.
- To support our Medicare Advantage members, we cover goals of care/advance care planning (ACP) conversations (CPT 99497 or 99498) at no cost share ($0 copay), regardless of the visit type or place of service.
- This benefit enhancement applies to telehealth (conducted via audio and video) and in-person visits.
- To ensure members are supported if their health status and/or wishes regarding care planning change, the benefit covers up to one ACP conversation per day with no annual limit.
- To support our Medicare Advantage members, we cover goals of care/advance care planning (ACP) conversations (CPT 99497 or 99498) at no cost share ($0 copay), regardless of the visit type or place of service.
Verify your patients' eligibility and benefits using Availity Essentials.
Tips for talking to your patients about palliative care and advance care planning
The Serious Illness Messaging Toolkit includes tips for how to talk about serious illness using evidence-based research.
It includes quick guides for having conversations about these topics:
Providers who participate in our Medicare Advantage Quality Incentive Program (MA QIP) and who complete advance care planning (ACP) conversations or report that an advance care plan has been previously recorded for their Asuris Medicare Advantage patients can earn incentive as follows:
- 20-29% gaps closed: $10/closed gap
- 30-39% gaps closed: $50/closed gap
- 40-59% gaps closed: $70/closed gap
- 60-79% gaps closed: $90/closed gap
- 80-100% gaps closed: $110/closed gap
View the eligible claim codes for gap closure in our Quality Measures Guide.
Specialty palliative care providers (certified and/or credentialed as palliative care): Medicare Advantage members can receive a specialty palliative care consultation without a copay. The claim for these encounters should include appropriate CPT code(s), along with ICD-10-CM Z51.5 Encounter for Palliative Care as the last diagnosis code. Only certified or credentialed palliative care sub-specialists may use Z51.5.
- Ancillary providers contracted for expanded serious illness member support (e.g., home health) should continue to submit claims using CPT 1150F.
Providers, including primary care providers (PCPs), may not use Z51.5 without palliative care certified clinicians delivering subspecialty level consultation.
PCPs: We encourage you to refer patients who can benefit from palliative care to specialty palliative care providers.
- Palliative Care (Administrative #136) reimbursement policy
- Palliative Care – Medicare Advantage (Administrative #136) reimbursement policy
- Incident To Services (Administrative #136) reimbursement policy
- Incident To Services – Medicare Advantage (Administrative #136) reimbursement policy
- Expanded telehealth claim submission guidelines
- Virtual Care (Administrative #132) reimbursement policy
- Virtual Care – Medicare Advantage (Administrative #132) reimbursement policy
We reimburse providers for conducting and documenting goals of care conversations, CPT 99497 or 99498 advance care planning (ACP), for all Asuris members.
For Individual and group members, the following codes are eligible for reimbursement (in addition to the ACP codes listed above):
- CPT 99509 (Home visit for assistance with activities of daily living and personal care)
- CPT 99510 (Home visit for individual, family or marriage counseling)
Our care management supports the unique needs of members with acute, chronic and major illness episodes or severe illness conditions. The mission of care management is to prioritize the needs of our members by providing personalized, equitable services that enhance their wellbeing.
We offer a single-nurse model dedicated to delivering personalized and holistic medical and behavioral health support to each member and their family. Case managers are experienced registered nurses and social workers. Our case managers work closely with providers to help our members improve their health and meet the goals of their providers' treatment plans.
Case managers can:
- Explain what your loved one’s health plan covers and translate health insurance jargon
- Help find in-network providers, get pre-authorization for services, schedule appointments and coordinate care
Connect you to free or low-cost community resources, like support groups
Learn more about our Care Management program.
- CaringInfo (National Hospice and Palliative Care Organization)
- Center to Advance Palliative Care (CAPC)
- Making Choices® Planning in Advance for Future Healthcare Choices, created in partnership with Respecting Choices:
- Palliative care Asuris member webpage
