tci Part B Insider - 2016 Issue 1

Reader Question: CMS Reps Address Time Thresholds for Advance Care Planning

Question: The new advance care planning code (99497) descriptor refers to “first 30 minutes face to face.” Is there a threshold that a practice must perform a minimum of 16 minutes before they can report one unit of the code? That is the case for other timed codes. Answer: Depending on your payer, that should be acceptable. “I believe that based on the way that the CPT® codes are written, for those codes like advance care planning that have a time component, CPT® has maintained that 16 minutes is that minimum threshold,” said CMS’s...

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