Advance Care Planning (ACP) is a face-to-face service where a physician and a patient discuss advance directives (such as living wills or medical powers of attorney). It is billed using CPT 99497.
Time-Based Billing for 99497
ACP is strictly a time-based code. 99497 represents the first 30 minutes of face-to-face conversation. To bill it, you must cross the midpoint, meaning the conversation must last at least 16 minutes.
| Code | Description | Time Required |
|---|---|---|
| 99497 | Advance care planning; first 30 mins | 16 - 45 minutes |
| 99498 | Add-on for each additional 30 mins | 46+ minutes |
Waiving the Copay (Modifier 33)
Normally, ACP is subject to the Medicare Part B deductible and coinsurance. However, if 99497 is performed on the exact same day as an Annual Wellness Visit (G0438 or G0439), append Modifier 33 to the 99497 code. This waives the patient's copay entirely.
NCCI Edits
If billed outside of an AWV (e.g., during a standard sick visit like 99214), you must ensure Modifier 25 is applied to the E/M code. Check NCCI edits to ensure proper unbundling.