Advance Care Planning CPT^® Codes Overview

Medical practices perform countless tasks every day for which there is no payment. CMS continually states that it wants to support non-procedural and in the past decade has added payment for some non-face-to-face services, including Care Plan Oversight, Transitional Care Management and Chronic Care Management.

CPT^® Codes 99497 & 99498

99497 is for the first 30 minutes, and +99498 is an add on code, for each additional 30 minutes.

CPT^® code definitions:

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

    +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))

CMS Advance Care Planning Resources

• CMS Fact Sheet – “Advance Care Planning”
• CMS FAQ page – “Frequently Asked Questions about Billing the Physician Fee Schedule for Advance Care Planning Services”