Awareness : Did You Know? 2015-2016

Did You Know? Weekly Educational Series 21

For the Week of January 25, 2016-Advanced Care Planning

Advance Care Planning (ACP) Services

CMS established Medicare payment for two ACP services effective January 1, 2016.  CPT codes 99497 and 99498.

ACP services involve face-to-face discussions of long-term treatment options and planning between a physician or other qualified health care professional and the patient, family member, or a surrogate. These services are not limited to particular physician specialties and may be furnished by physicians or non-physician practitioners (NPPs) whose scope of practice includes these services and who may independently bill Medicare.  These services may be rendered in several facility settings including, POS 21, 22, 23 and 11.

These are time-based codes, therefore TIME must be documented.

ACP services may be billed on the same day as other evaluation and management services, during the same service period as transitional care management or chronic care management services and within global surgical periods, with modifier - 24. They may also be provided during an annual wellness visit (AWV) when billed separately with modifier -33 (preventive services). When these services are provided as part of an AWV, the Medicare the Part B deductible and coinsurance will be waived; when provided separately from an AWV, patients will be responsible for standard Part B deductible and co-insurance. ACP services may not be billed on the same day as critical care services, including neonatal and pediatric critical care.