Advanced Care Planning
ACP is a voluntary, face-to-face discussion between you and your patient, their family member, caregiver or surrogate (as appropriate) to discuss the patient’s health care wishes if they become unable to make their own medical decisions.
As part of this discussion, you may talk about advance directives with or without helping a patient complete legal form(s) An advance directive appoints an agent and records a patient’s medical treatment wishes based on their values and preferences. Advance directives can differ from state to state, and you can generally find them through your state attorney general.
The two key words in the CMS description of this service are “advance” and “if”, because these words define important parameters around the service. It was approved by CMS to represent a voluntary discussion between the provider and the patient, performed at a time when the patient is fully cognizant and capable of making planning decisions, preliminary to any future point in time when the patient may become unable to make such decisions.
CMS did not approve this as a service representing a bedside decision in a medical and/or surgical crisis. Once the patient has lost the mental or physical capacity to make ACP decisions, a provider cannot document the patient’s advanced wishes, and this is contrary to the code’s intended purpose.
Decisions made by the patient during an ACP service may be altered at any point by the patient, when fully cognizant, or by a family member or caregiver who has been appointed by the patient as a health care proxy via a separately obtained advance directive. An ACP discussion is billable for physicians, NPs and PAs as a face-to-face service to talk about advanced healthcare directives with or without helping a patient needing to complete the appropriate “legal forms”.
Table of Contents
Billing Codes
| CPT Codes | Coding Descriptions |
|---|---|
| 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 | 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; each additional 30 minutes (List separately in addition to code for primary procedure 99497) |
Billing Information
You don’t need to report a specific diagnosis to bill for ACP services. Report the condition you discuss with the patient using an ICD-10-CM code. This code shows an administrative exam or an exam diagnosis when ACP services are part of the annual wellness visit (AWV).
ACP are time-based codes; therefore, follow CPT rules about minimum time requirements for reporting and billing ACP services. A unit of time is billable when the midpoint of the allowable unit of time passes.
Discuss ACP issues during the time you’re billing for ACP services. Don’t discuss any other active management of a patient’s issues for the time reported when you bill ACP codes. When you perform another time-based service concurrently, don’t include the time spent on the concurrent service with the ACP service.
Bill a different Evaluation and Management (E/M) service, like an office visit, for an ACP discussion of 15 minutes or less.
Note: ACP time cannot overlap with actively managing those E/M conditions.
ACP may be billed:
- An optional element of the AWV
- A separate Medicare Part B medically necessary service
- ACP Part B deductible and coinsurance is waived when the ACP is:
- Provided on the same day as the covered AWV (HCPCS codes G0438 or G0439)
- Provided by the same provider as the covered AWV
- Billed with modifier 33 (Preventive Services)
- Billed on the same claim as the AWV
If we deny the AWV billed with ACP for exceeding the once-per-year limit, we’ll apply the ACP deductible and coinsurance.
There are no limits on the number of times you can report ACP for a certain patient in a certain period. When billing ACP multiple times in a year, document changes in the patient’s health status or wishes about their end-of-life care.
For patients enrolled in hospice, you can bill ACP services under Medicare Part B only if the physician or practitioner are not employed by the hospice agency; otherwise, the claim is billed through the hospice agency.
Documentation
Documentation to support ACP should include:
- The fact that the visit was voluntary
- Who was present
- The time spent discussing ACP
- Any change in health status or health care wishes
- Details and discussions, well-being goals, aspirations, needs, self-care, support, test results, summary of diagnosis, medication details and clinical notes
- Explanation of advance directives
- Time spent discussing ACP during face-to-face encounter
- Who was present during the face-to face encounter
You must document your ACP discussion with the patient, their family member, caregiver, or surrogate (as appropriate).
Note: If you bill these services more than once, document a change in the patient’s health status or wishes about end-of-life care in their medical record.
Related Content
- Helpful Reminders on Advance Care Planning
- MLN® Fact Sheet: Advance Care Planning
- 42 CFR 489, Subpart I (advance directives policy)
- 2016 Medicare Physician Fee Schedule Final Rule (Medicare PFS policy for ACP services)
- Advance Care Planning (patient information)
- CMS IOM, Publication 100-04, Medicare Claims Processing Manual, Chapter 4, Section 200.11
- CMS IOM, Publication 100-04, Medicare Claims Processing Manual, Chapter 18, Section 140.8
- Frequently Asked Questions about Billing the Physician Fee Schedule for Advance Care Planning Services
Revised 7/9/2025