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Provider Billing for Advance Care Planning

Changes in Medicare reimbursement policies went into effect in January 2016. These changes provide an opportunity for more clinicians and patients to engage in advance care planning (ACP) conversations about preferences for care at the end of life.

Hospitals, physicians and other practitioners can use the following codes to file claims for advance care planning services:

CPT Codes and Descriptors

CPT CodesBilling Code Descriptors
99497Advance 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 patient, family member(s), and/or surrogate.
99498Advance 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).

Courtesy of Centers for Medicare & Medicaid Services (2016)

There are no limits on the number of times advance care planning can be reported for an individual in a given time period. The Centers for Medicare and Medicaid Services (CMS) have not established any frequency limits. However, when ACP is billed multiple times for an individual patient, there is an expectation to see a documented change in the patient’s health status and/or wishes regarding their health status.