Advance Care Planning Codes Billable Jan 1, 2016

As part of the final rule, CMS announced its plans to move forward with activation of:

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] ; and
An 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)].

These activities may be billed on the same day or on a different day from billing of other Evaluation and Management (E&M) services, but may not be billed on the same date of service as certain critical care services including neonatal and pediatric critical care.

Following is information provided by CMS in response to numerous comments on the proposal to active the ACP codes beginning January 1, 2016: