Advance Care Planning May Include:
- Discussion of goals and preferences for care
- Complex medical decision-making regarding life-threatening or life-limiting illness
- Explanation of relevant advance directives, including (but NOT requiring) completion of advance directives
- Engaging patients, family members and/or surrogate decision makers, as clinical situation requires
Who Can Provide Service
- “Qualified” providers defined under Medicare Part B can report ACP codes for payment
- Physicians (MD/DO), Nurse Practitioners and Physician Assistants, Clinical Nurse Specialists
- Other team members via applicable ‘incident to’ requirements
- Permitted to bill under National Provider Identifier Number: Social Workers, Registered Nurses, Chaplains, Psychologists, Case Managers
Where ACP Can Be Performed
- There are no place of service limitations on the ACP codes
- ACP codes may be billed by qualified providers in any clinical setting:
- Hospitals with the exception of the ICU
- Skilled nursing facility
- Long-term care
- Assisted living facilities
- Private offices
- In the home
- Medicare waived the face-to-face requirement for billing, allowing for telephonic and telemedicine encounters to be billed
What should be included in the ACP visit note?
- Relevant diagnoses
- Who was present for the meeting:
- Involved (and supervising) clinicians
- Involved patient, family, surrogates
- Where the meeting took place
- Visit content:
- Documents completed, if any
- Decisions made, if any
- Time spent in ACP discussion
CPT Codes for ACP Services
| Code | Description |
| 99497 | Advance Care Planning including the explanation and discussion of advance directives such as standard forms (including the completion of such forms, when performed), by the physician or other qualified health professional; used for the first 30 minutes with the patient, family members and/or surrogate |
| 99498 (add-on) |
Each additional 30 minutes |
