The Advance Care Planning Fact Sheet

 In Articles, Coding & Documentation, News

What is Advance Care Planning?

Advance Care Planning (ACP) is a billable, face-to-face service with a patient, family members, and/or surrogates in which the patient’s wishes for future medical care and place of treatment are discussed. ACP services should include discussion and counseling pertaining to advance directives (official documentation of patient’s wishes that may be referenced later, if a patient has lost the capacity to make decisions regarding his or her care). Service may or may not include completion of relevant legal forms for advance directives.

When can ACP be performed?

  • ACP can be performed on the same date as other E & M services, Transitional Care Management, Chronic Care Management, within global service periods, and at Medicare Annual Wellness Visits. ACP services may not be billed on the same date as some Critical Care services.
  • CMS is currently collecting information about implementation and utilization of these services, and has not yet issued a national coverage determination (NCD.) So at least for now, there is no frequency limitation in place for these services.
  • Medicare will pay ACP services at 100% when billed with an Annual Wellness Visit. When billed alone or with any other non-preventive service, the patient will be responsible for Medicare’s 20% coinsurance.

Billing and Reimbursement

  • Advance Care Planning CPTs:
    • 99497, first 30 minutes
    • 99498, each additional 30 minutes
  • The average national payment for these services is as follows:
    • 99497, $85.99
    • 99498, $74.88
  • When performed with a Medicare Annual Wellness Visit (AWV), append modifier -33 (Preventive Services).
  • ACP services can be performed on multiple occasions and by different providers, provided that documentation supports a change to patient’s health status and/or wishes regarding end-of-life care

Download the At-A-Glance Advanced Care Planning Guide by MSOC Health HERE.

Please also refer to:

Frequently Asked Questions about Billing the Physician Fee Schedule for Advance Care Planning Services,” published by CMS.

MGMA’s “Quick Guide to Medicare Advance Care Planning Services.”

References and excellent resources for additional reading:

Benson, W., & Aldrich, N. (2012). Advance Care Planning: Ensuring Your Wishes Are Known and Honored If You Are Unable to Speak for Yourself. Retrieved July 05, 2016, from Centers for Disease Control.

Daly, R. (2016, April 15). Few Physicians Utilize Medicare Advance Care Planning Benefit: Survey. Retrieved from HFMA.org.

Detering, M. K., & Silveira, M. M. (2016, June 16). Advance care planning and advance directives. Retrieved July 5, 2016, from UpToDate.com.

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