Monday, February 23, 2015

New CPT Codes for Advanced Care Planning

New CPT Codes for Advanced Care Planning

The two new advanced care planning codes (99497 and 99498) are used to report the face-to-face service between a physician or other qualified healthcare professional (QHCP) and a patient, family member, or surrogate in counseling and discussing advance directives, with or without completing relevant legal forms. 
 
The CPT manual defines an advanced directive as, “A document appointing an agent and/or recording the wishes of a patient pertaining to his/her medical treatment at a future time should he/she lack decisional capacity at that time.” 

These are time-based codes, with 99497 to be billed for the first 30 minutes, and 99498 for each additional 30 minutes.  Because the purpose of the visit is the discussion, no active management of the patient’s problem(s) is performed during the time of these visits.

Medicare has indicated that it will NOT pay for codes 99497 or 99498 in 2015.

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