Palliative Care Billing Services
Palliative care teams spend a lot of time on conversations: symptom plans, goals of care, and decisions with families. These visits can run long, and the work is not always tied to a procedure. Billing depends on good time records and notes that show what was discussed and why it mattered.
Teams also work across settings, from hospital wards to patients' homes, and some patients later enroll in hospice, which changes who bills. Westmont Revenue Partners connects palliative practices with vetted billing experts who understand these workflows and can help turn careful documentation into clean claims.
Who this is for
- Palliative care physicians, nurse practitioners, and physician assistants
- Hospital-based palliative consult teams
- Community-based and home-based palliative programs
- Cancer centers with supportive care clinics
- Practices that serve patients in nursing facilities
What gets billed
- Initial palliative consultations
- Follow-up visits for symptom management
- Advance care planning conversations
- Home visits for patients who cannot travel
- Nursing facility visits
- Hospital inpatient visits
- Family meetings tied to care decisions
- Telehealth visits where allowed
- Prolonged service time when documented
- Care coordination for complex patients
Commonly billed codes
| Code | Type | What it covers |
|---|---|---|
| 99223 | CPT | High-complexity initial hospital visit |
| 99233 | CPT | High-complexity follow-up hospital visit |
| 99214 | CPT | Established patient office visit of moderate complexity |
| 99347 | CPT | Established patient home visit with straightforward decision making or short time |
| 99497 | CPT | Advance care planning discussion, first 30 minutes |
| 99498 | CPT | Each added 30 minutes of advance care planning |
| Z51.5 | ICD-10-CM | Encounter for palliative care |
| POS 12 | Place of service | Care delivered in the patient's home |
| POS 21 | Place of service | Care delivered to an inpatient in a hospital |
Note
Codes are examples for orientation, not a complete list, and do not guarantee coverage or payment. Always check current code sets and payer policy.
Billing challenges in palliative care
Advance care planning rules. Time, the voluntary nature of the talk, and who took part must be written in the note. A palliative biller checks that these elements are present and that the claim fits payer policy.
Primary diagnosis choice. A palliative encounter code alone may not show why the patient needs care. Billers pair it with the underlying illness and symptom diagnoses, following coding rules.
Hospice overlap. Once a patient elects hospice, services related to the terminal illness are usually billed through hospice. Billers verify election dates and use proper modifiers for visits that are not related.
Time-based documentation. Long visits can support higher billing levels or add-on time if the notes record minutes and activities. Billers coach teams on what to capture.
Care across settings. The same clinician may see patients in a hospital, a home, and a facility on one day. Billers use the correct place of service and rate for each.
Prior authorization and payer variety. Some Medicare Advantage and Medicaid plans have palliative programs with their own rules. Billers track these and confirm benefits.
Cost-sharing conversations. Patients may owe copays on frequent visits. Billing staff handle statements with care and explain charges plainly.
How Westmont can help
- We match your palliative team with vetted billing experts who have experience in palliative care and end-of-life services.
- Matched experts can support end-to-end revenue cycle management across hospital, home, and clinic settings.
- Denial management support addresses hospice overlap and advance care planning rejections.
- Credentialing and enrollment support is available for new clinicians and programs.
Frequently asked questions
Can palliative care providers bill for advance care planning?
Yes, in many cases. Time-based advance care planning codes can be billed when the discussion is documented, including who was present and how long it lasted. Medicare generally allows it, and many other payers follow similar rules. Confirm current payer policy and any frequency limits.
Does palliative care billing change when a patient enters hospice?
It can. Once a patient elects hospice, services related to the terminal illness are usually part of the hospice benefit. A palliative provider may still bill for care that is unrelated, using modifiers where required. Always verify election dates first.
Can nurse practitioners bill for palliative visits?
Nurse practitioners and physician assistants can generally bill under their own credentials when payer and state rules allow. Shared visits with a physician follow specific rules. A palliative care billing company can set up workflows that follow current policy.
What documentation supports palliative billing?
Notes should show the reason for the visit, symptoms addressed, decisions made, and time when billing by time. For advance care planning, record who took part and what was discussed. Clear notes help in audits and appeals.
Are home palliative visits covered?
Many payers cover home visits when they are medically necessary and documented, but coverage varies. Medicare has specific rules for who qualifies for home services. A palliative care medical billing expert can check benefits and set up claims with the proper place of service.
Related billing services
See what simpler billing looks like
Tell us about your practice and we will connect you with vetted billing experts. Contact Westmont for a quote.
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