Palliative care involves some of the most complex, time-intensive patient encounters in medicine. We make sure that complexity is reflected in your reimbursement — accurately, compliantly, and consistently.
Palliative care providers deliver high-complexity, high-touch care that is often underbilled. The work is cognitively intensive, involves multiple team members, and spans settings from the clinic to the patient's home. Getting paid what you're owed requires a biller who understands the nuances.
Palliative care encounters almost always qualify for higher-level coding based on Medical Decision Making complexity. Many providers underbill because they default to time without evaluating MDM. We help ensure the right method is applied.
When a patient is on Medicare Hospice, billing rules change significantly. The GV and GW modifiers, and knowing which conditions are related vs. unrelated to the terminal diagnosis, directly affect what can be billed to Part B.
CPT codes 99497 and 99498 cover advance care planning conversations and represent real revenue. Many palliative care practices leave these unbilled simply because they don't have a billing partner tracking them.
CCM, PCM, and the newer APCM codes allow ongoing reimbursement for care coordination between visits. These monthly codes are frequently missed and can substantially improve your bottom line.
Palliative encounters routinely exceed standard time thresholds. Prolonged service add-on codes exist precisely for this situation, but require precise documentation and the right G-code selection for Medicare.
Medicare prohibits billing separately when two providers in the same group/specialty see the same patient on the same day. Understanding how to correctly bundle documentation is essential to avoid denials.
Our team is familiar with the full range of codes used in palliative care practice, including:
| Code | Service | Notes |
|---|---|---|
| 99202–99215 | Office/Outpatient E/M Visits | Time-based or MDM; higher levels common in palliative care |
| 99221–99223 / 99231–99233 | Inpatient Hospital Visits | Initial and subsequent; time or MDM |
| 99497–99498 | Advance Care Planning | First 30 min + additional 30-min add-on; frequently underbilled |
| 99490 / 99491 | Chronic Care Management | Monthly; requires 20+ min of clinical staff time |
| 99424–99427 | Principal Care Management | For patients with single high-risk condition |
| G0556–G0558 | Advanced Primary Care Management | New 2024 APCM codes; valuable for chronic condition patients |
| GV / GW modifiers | Hospice Modifiers | Required for Part B billing when patient is on Medicare Hospice |
| 99356–99357 | Prolonged Inpatient Services | Add-on codes for extended time beyond the E/M threshold |
This table is for general reference only. Correct code selection always depends on individual documentation and clinical circumstances.
Palliative care providers are caring for patients in some of the most sensitive moments of their lives. The last thing you need is a billing partner who treats your account like a ticket number.
A.W. Medical Billing LLC is based right here in Tucson. We know Arizona's payer landscape, including AHCCCS nuances that national billing companies overlook. When you call us, you talk to us. When something needs to be escalated, it gets escalated — not queued.
We also understand the relationship between billing and documentation. We work with your team to ensure that the care you're providing is clearly captured in the record so the codes we submit are defensible and complete.
We offer a free, no-obligation consultation for palliative care providers in Tucson and Southern Arizona. We'll review your current billing situation and tell you honestly where we can help.
Led by Alda Wong, AAPC Certified Professional Coder (CPC) and Certified Professional Biller (CPB) — your claims are reviewed by a credentialed professional, not a data-entry operator.