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Helpful Reminders on Advance Care Planning

ACP billing codes:

  • 99497: Advance care planning, including the first 30 minutes of face-to-face explanation and discussion (when performed) of advance directives such as standard forms.
  • 99498: Each additional 30 minutes.

CMS defines ACP as “… a voluntary, face-to-face service between a physician or other QHP and a patient, family member, caregiver, or surrogate to discuss the patient’s health care wishes if they become unable to make their own medical decisions.” in the MLN® Fact Sheet Advance Care Planning.

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”.

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Updated 4/18/2024