Physician Practice

CMS clarifies coding and billing for advance care planning

Physician Practice Insider, October 4, 2016

CMS released a fact sheet regarding the coding and billing of advance care planning services, following the July release of an FAQ document on the topic.

CMS began paying for the following services January 1 as part of the Medicare Physician Fee Schedule and OPPS updates:

  • 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 healthcare professional; first 30 minutes, face-to-face with the patient, family member(s), and/or surrogate
  • Add-on code 99498, each additional 30 minutes (List separately in addition to code for primary procedure)

CMS notes that payments are made for voluntary advance care planning, which is a discussion about the care a patient would want to receive if he or she became unable to speak for themselves. The fact sheet covers beneficiary, provider, and location eligibility requirements, as well as coding and billing tips and links to additional resources on the topic.

This article originally appeared on Medicare Compliance Watch.

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