99497 Advance care planning Medicare reimbursement rates in Virginia

This service covers a face-to-face conversation in which a physician or qualified nonphysician practitioner explains advance directives and helps the patient, family, or surrogate consider goals of care, preferred treatments, and who should make decisions if the patient cannot. Completing a health care proxy or living will is included when it happens, but a completed form is not required. Primary care, geriatrics, oncology, palliative care, nephrology, and hospitalist clinicians furnish it in offices, hospitals, nursing facilities, and patient homes.

The code is time-based. Under the CPT midpoint rule, at least 16 minutes of advance care planning time must be documented. At 46 minutes, add 99498 for the first additional 30-minute unit; another unit begins at 76 minutes. Documentation should show voluntary participation, who was present, what was discussed, any forms completed, and ACP time separate from other services. Medicare sets no frequency limit, but repeated discussions should document changes in health status or wishes. When ACP is furnished with an Annual Wellness Visit, report the applicable ACP code or codes with modifier 33 for waived Medicare deductible and coinsurance.