Billing and Coding: Advance Care Planning

Advance Care Planning (ACP) is a covered, voluntary face-to-face service when provided by qualified Medicare practitioners (MD/DO, NP, PA, CNS) to patients and/or family/surrogates and may be billed as part of an Annual/Medical Wellness Visit or as a separate Medicare Part B service using CPT codes 99497 and 99498. ACP can be furnished in office, facility, SNF, home, or via telehealth; documentation must include content, medical necessity, voluntary agreement, participants, and time (start/end times recommended). Only authorized practitioners may bill ACP codes, no active medical management may occur during ACP time, CPT time minimums apply, and special billing/payment rules exist for hospice-employed practitioners, CAHs, FQHCs, and RHCs.

"Advance Care Planning (ACP) is covered when performed face-to-face by a Medicare physician or other qualified health care professional with the patient and/or family member(s) and/or surrogate to d..."