That difficult conversation you have with patients about their end-of-life care is now one you can get paid for. As of Jan. 1, 2016, Medicare pays for voluntary advance care planning (ACP), or end-of-life care planning, for Medicare patients.
Medicare already has been paying for advance care planning under the Welcome to Medicare visit available to all Medicare beneficiaries, but patients may not need these services when they first enroll. Now Medicare pays separately for these two Current Procedural Terminology (CPT) codes:
- CPT code 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 professional; first 30 minutes, face-to-face with the patient, family member(s) and/or surrogate
- Add-on CPT code 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 professional; each additional 30 minutes (list separately in addition to code for primary procedure)
Billing Medicare for ACP
When you provide advance care planning as an optional element of Medicare patients’
annual wellness visit, the patient’s deductible and coinsurance don’t apply to the ACP services because they are considered preventive (i.e., furnished on the same day and by the same physician as part of an annual wellness visit). To preclude the patient’s being charged those costs, bill both the ACP and the annual wellness visit together on the same claim, appending modifier 33 (preventive services) to the ACP code(s).
Because payment for an annual wellness visit is limited to only once a year, Medicare will waive the deductible and coinsurance for ACP only once a year. The deductible and coinsurance do apply when ACP is not furnished as part of a covered annual wellness visit. For details, read CMS'
guidance document and
FAQs about billing ACP. You also can find more information in CMS’
MLN Matters No. MM9271.
Medicare payment for CPT code 99497 for the Rest of Texas payment area is $83 (the lowest amount paid). Use the
physician fee schedule look-up tool on the Novitas Solutions website for payment amounts in your area. If you have questions about billing and coding, contact the specialists at
paymentadvocacy[at]texmed[dot]org for help, or call the TMA Knowledge Center at (800) 880-7955.
Revised March 31, 2016
Last Updated On
September 26, 2016
Originally Published On
January 13, 2016