Beginning on Aug. 1, 2013, Colorado Medicaid began coverage of end-of-life counseling, or advanced directives, by primary care providers and other specialty providers caring for persons with serious, chronic, or terminal illness relating to the Medical Orders for Scope of Treatment. The Medical Orders for Scope of Treatment (MOST) is a medical order set defining patient choices for certain life-sustaining treatments. The MOST orders are portable across all health care settings and intended as a key device in maintaining continuity of care and communication.

The procedure code for this service is S0257; it is billed in addition to the appropriate Evaluation and Management service. The provider types eligible to render this service are physician, advanced practice nurse, physician assistant, or licensed mental health provider. The reimbursement for this service is available once a year for persons with serious, chronic, or terminal illness. The Department of Health Care Policy and Financing would like to encourage providers to provide and bill for this service for appropriate clients.

The reimbursement for this service is $40 for a 30-minute session; however, to qualify for reimbursement, providers must complete a brief training module on the Medical Orders for Scope of Treatment process and form, available from Life Quality Institute; registration fees will be waived for providers seeking to qualify for this payment. The one-hour training module is offered in an online/on-demand format; a passing score on a brief post-test will generate a certificate of completion for your records. Please visit the Life Quality Institute website for details (www.lifequalityinstitute.org) or call 303-398-6317. Providers should keep the certificate on file and do not need to provide anything to the Department of Health Care Policy and Financing.

Providers should counsel and provide the necessary forms and guidance to comply with the Medical Orders for Scope of Treatment law as found at Colorado Revised Statutes, sections 15-18.7-101 et seq. and in accordance with the “Getting the MOST Out of the Medical Orders for Scope of Treatment: Guidelines for Healthcare Professionals” implementation instructions available from Life Quality Institute website. Additional provider and patient resources are available from Life Quality Institute, www.lifequalityinstitute.org, and from the Colorado Advance Directives Consortium, www.coloradoadvancedirectives.com.

For more information on the Medical Orders for Scope of Treatment process and form, please contact Jennifer Ballentine, Life Quality Institute, jballentine@lifequailtyinstitute.org. For further information on the coverage of the procedure, contact Richard Delaney at richard.delaney@state.co.us or 303-866-3436.


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