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Is advanced care planning billable?


Physicians can bill advanced care planning regardless of whether a patient fills out the relevant legal forms, but should review payer contracts to ensure it is a billable service.

• CPT code 99497 (Advanced care planning, first 30 minutes)

• CPT code 99498 (Each additional 30 minutes)

Payment information: CMS began paying for advanced care planning in 2016. The 2017 national Medicare payment for the first 30 minutes of advanced care planning is $82.90. Each additional 30 minutes yields a national average of $72.50.


Quiz: Do you know your TCM codes?


Advanced care planning refers to the face-to-face discussions between a physician and patient (or the patient’s family member or surrogate) regarding advance directives-legal documents appointing an agent and/or recording a patient’s wishes regarding medical treatment during a time of incapacitation. Physicians can bill advanced care planning regardless of whether a patient fills out the relevant legal forms.

However, before billing advanced care planning, physicians should review their contracts to determine whether this is a payable service, says Raemarie Jimenez, CPC, CPC-I, vice president of membership and certification solutions at AAPC. Some commercial payers, for example, bundle payment for advanced care planning into their evaluation and management (E/M) payments even though Medicare allows physicians to separate the two, she adds.

If a carrier does pay for advanced care planning, be sure to document the face-to-face time spent counseling and discussing advance directives with the patient and/or caregiver. Examples of advance directives include, but aren’t limited to, a healthcare proxy, durable power of attorney for healthcare, living will and medical orders for life-sustaining treatment.


Further reading: Here's why high-level E/M codes mean more money


CPT code 99497 denotes 30 minutes of services. To report this code, physicians must render a minimum of 16 minutes of services. CPT code 99498 requires a minimum of 46 minutes. Most physicians don’t meet the minimum time requirements, which may be one reason why payers scrutinize-and frequently deny-these codes, says Kim Huey, MJ, CHC, CPC, an independent coding and reimbursement consultant. Another reason may be that the documentation doesn’t include specific details regarding the discussion about advanced care planning, she adds.


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