Advance care planning (ACP) is the face-to-face time a physician or other qualified health care professional spends with a patient, family member, or surrogate to explain and discuss advance directives.
The two CPT codes used to report ACP services are:
Advance care planning services should not be reported on the same date of service as critical care services (i.e., CPT codes 99291 and 99292), neonatal and pediatric critical care codes, and some intensive hospital care services.
Requirements for CPT Code 99497:
Requirements for CPT Code 99498 (Add on code):
Non-physicians must legally be authorized and qualified to provide ACP in the state in which the services are furnished.
Discussing end-of-life decisions with your patients and their families can be difficult and uncomfortable, but as a patient's primary care physician, family physicians are ideally suited to facilitate this conversation. Learn more about how to get paid for this service.
The AAFP’s advocacy efforts helped pave the way for ACP payment. We supported the creation of CPT codes for ACP and applauded their inclusion in the 2016 Medicare physician fee schedule. Medicare payment for ACP gives family physicians an opportunity to be paid for the time they commit to conversations with their patients about end-of-life decisions.
All traditional Medicare beneficiaries qualify for ACP services. You may determine that it is important to have conversations about end-of-life decisions with your patients and/or their caregivers annually, or when a patient has a medical change in status. The patient has no out-of-pocket responsibility for ACP that takes place during his or her Medicare Annual Wellness Visit (AWV). However, if ACP services are provided under any other circumstances, Medicare coinsurance and deductibles apply.
Medicare Advantage and other insurance payers may pay for ACP. You should confirm a patient’s coverage before you provide these services. It is also important to remember that if a payer does pay for CPT codes 99497 and 99498, these services are subject to the insurance carrier’s billing policies, like all other covered services.