You can charge for Advanced Care Planning (ACP)

by  Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
Oct 5th, 2016

Did you know you could be charging for Advanced Care Planning (ACP). Effective January 1, 2016, payment for the service described by 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 care professional; first 30 minutes, face-to-face with the patient, family member(s), and/or surrogate) is conditionally packaged under the OPPS and is consequently assigned to a conditionally packaged payment status indicator of "Q1."

When this service is furnished with another service paid under the OPPS, payment is packaged; when it is the only service furnished, payment is made separately. 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 care professional; each additional 30 minutes (List separately in addition to code for primary procedure)) is an add-on code and therefore payment for the service described by this code is unconditionally packaged (assigned status indicator ‘‘N'') in the OPPS in accordance with 42 CFR 419.2(b)(18).