• CMS answers billing questions on advance care planning

    Medicare began paying for advance care planning services on Jan. 1. As with most new reimbursement programs released by the Centers for Medicare & Medicaid Services (CMS), physicians have had questions. Last week, CMS attempted to answer some of them.

    Advance care planning services are described by two Current Procedural Terminology (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.
    •    +99498, Each additional 30 minutes (List separately in addition to code for primary procedure).

    Among the highlights in the CMS’s answers:

    •    CMS will follow CPT provisions regarding minimum time required to report the service; that means a unit of time is attained when the mid-point is passed.
    •    CMS has not established any frequency limits for these services.
    •    There are no place of service or physician specialty limitations on the codes.
    •    Medicare administrative contractors will determine any documentation requirements.
    •    Completion of an advance directive is not required to bill the service.
    •    Advance care planning can be reported in addition to other evaluation and management services, except certain critical care services.
    •    No specific diagnosis code is required with advance care planning codes.
    •    These services are subject to the usual Part B deductible and coinsurance unless furnished as an optional element of the Medicare annual wellness visit.

    For additional information, CMS encourages you to read pages 70955-70959 of the final rule on the 2016 Medicare physician fee schedule and Medicare Learning Network Matters article MM9271.


    – Kent Moore, senior strategist for physician payment for the American Academy of Family Physicians

    Posted on Mar 28, 2016 by David Twiddy

    Disclaimer: The opinions and views expressed here are those of the authors and do not necessarily represent or reflect the opinions and views of the American Academy of Family Physicians. This blog is not intended to provide medical, financial, or legal advice. Some payers may not agree with the advice given. This is not a substitute for current CPT and ICD-9 manuals and payer policies. All comments are moderated and will be removed if they violate our Terms of Use.