Get Paid for Providing Advance Care Planning to Patients

AAFP Creates FAQ to Support Family Physicians

May 25, 2016 02:38 pm News Staff

On Jan. 1, CMS began paying physicians for providing advance care planning services to their Medicare patients when it implemented payment for CPT codes 99497 and 99498.

[Elderly woman holding hands with physician]

For family physicians who've not yet embraced these codes, 99497 allows for billing the first 30 minutes of face-to-face time with the patient, family members and/or other surrogates when, for instance, explaining advance directives -- including discussing standard forms and the completion of such forms.

CPT code 99498 covers each additional 30 minutes of advance care planning services.

The AAFP supported the creation of the codes and applauded their inclusion in the 2016 Medicare physician fee schedule.

However, as with all things new and unfamiliar, implementation of the new codes prompted a barrage of questions from family physicians concerned about applying them correctly.

Here's a sampling of questions the AAFP has received about the advance care planning codes in the past few months:

  • Are minimum amounts of time required to bill these codes?
  • Are there limits to how often a physician can bill the CPT codes?
  • In what settings can advance care planning services be provided and billed?
  • Who can perform these services?
  • What are the documentation requirements?
  • Can advance care planning be reported in addition to an evaluation and management service?

"We answered those questions and many more and then took member service one step further," said Barbara Hays, C.P.C., C.P.M.A., the AAFP's coding and compliance specialist.

"We asked CMS during a physician Open Door Forum call in February to provide an official Q&A guidance for physicians on the advance care planning codes.

"CMS responded by asking the AAFP to create one," said Hays.

The AAFP subsequently wrote, edited and submitted to CMS a question-and-answer document based on queries similar to those listed above that they already were fielding from anxious physicians.

Hays partnered with Kent Moore, the AAFP's senior strategist for physician payment, to write the advance care planning guide titled "Frequently Asked Questions about Billing the Physician Fee Schedule for Advance Care Planning Services."(

CMS recently published the resource on its website, and that means family physicians now have access to clear and concise answers -- written in physician-friendly language -- to a dozen of the most commonly asked questions about utilizing advance care planning codes.

Most importantly, physicians have the opportunity to be properly paid for providing an important service to their Medicare patients.

Related AAFP News Coverage
2016 Proposed Medicare Physician Fee Schedule
AAFP Lauds Payment Stability, Action on Advance Care Planning Codes


'Care Planning Act' Gets Big Thumbs Up From AAFP
Bill Would Safeguard Medicare Beneficiaries' End-of-Life Wishes


More From AAFP

Advance Care Planning

Family Practice Management's Getting Paid Blog: CMS considers separate payment for advance care planning
(July 9,2015)

Letter to CMS on advance care planning CPT codes(5 page PDF)
(Dec. 30, 2014)