Advanced Care Planning 99497, 99498

January 6th, 2016 - Codapedia Editor

Primary care practices perform countless tasks every day for which the payment is: nothing, zero, nada. CMS continually states that it wants to support primary care, and in the past few years has added payment for some non-face-to-face services, including Care Plan Oversight, Transitional Care Management and Chronic Care Management. In 2015, the AMA developed new codes to pay for discussions of end of life planning, but in 2015, CMS didn’t allow them as payable services. However, starting in January, 2016, CMS will recognize and reimburse physicians and Non-Physician Practitioners to provide this service, using CPT codes 99497 and 99498.

These are time-based codes. 99497 is for the first 30 minutes, and 99498 is an add on code, for each additional 30 minutes. These codes were defined in the 2015 CPT book.
 
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)) 

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