ACC members who provide Advance Care Planning (ACP) continue to seek clarity on when it is appropriate to bill codes 99497 and 99498. Below are some tips and additional resources.

CPT codes 99497 - Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; first 30 minutes, face-to-face with the patient, family member(s), and/or surrogate and add-on CPT code 99498 - Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; each additional 30 minutes (List separately in addition to code for primary procedure) are used to report face-to-face services between a physician or other qualified health care professional and a patient, family member or surrogate in counseling and discussing advance directives, with or without completing relevant legal forms. When using these two codes, no active management of the problem(s) is undertaken during the time period reported.

Frequently Asked Questions

Q:  Can ACP codes be coded on the same day as an Annual Wellness Visit (AWV) codes G0438 or G0439?

A:  Yes, per Centers for Medicare and Medicaid Services (CMS) ACP services furnished on the same day and by the same provider as an AWV are considered a preventive service. The following would apply:

• The deductible and coinsurance would not apply to either the AWV or the ACP services
• When the AWV and ACP are billed on the same day by the same provider they are reimbursed under the Medicare Physician Fee Schedule rates. 

Q:  If the ACP is billed alone without any other service is it still considered a preventative service?

A:  If the ACP is coded separately it is not treated as preventative and the patient’s deductible and coinsurance will be applied to the ACP.

Q:  Can I code for ACP when performed on the same day as another Evaluation and Management (E/M) service?

A:  Yes, the 2017 CPT book gives guidance on the many E/M codes that you can code when coding an E/M service on the same day. You would also have to use an appropriate Modifier.

Keywords: Advance Care Planning, Centers for Medicare and Medicaid Services, U.S., Current Procedural Terminology, Deductibles and Coinsurance, Fee Schedules, Medicaid, Medicare

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