Beginning January 1, 2016, Medicare will pay healthcare providers for advance care planning (ACP) discussions with Medicare beneficiaries. Authorization for payment is set forth in the November 2015 Final Rule, published by the Centers for Medicare and Medicaid Services (CMS).
In order to be billable under Medicare, advance care planning discussions must be face-to-face conversations with Medicare patients and/or their surrogates (the patient does not need be present), and cover the patient’s specific health conditions, their options for care and what care best fits their personal wishes, and the importance of sharing those wishes in the form of a written document.
May 15, 2016: Medi-Cal creates codes to allow billing by providers for advance care planning discussions with beneficiaries. Learn more.
Download this FAQ as a handout (PDF): Updated November 2017
Frequently Asked Questions
What Qualifies As “Advance Care Planning” For The Purposes Of These Codes?
Are There Any Limitations On The Place Of Service For The ACP Codes?
Which Providers Can Bill These Codes?
Who Can Provide The ACP Service Billed Under These Codes?
Are There Minimum Amounts Of Time Required To Bill These Codes?
Can The Codes Be Used More Than Once?
Is Code 99497 Always Billed First?
Which Patients Qualify For This Service?
Must A Specific Diagnosis Be Used?
Can ACP Services Be Furnished Without Beneficiary Consent?
Is There A Cost To The Patient For The ACP Discussion?
Does The Patient Have To Be Present?
Are Telephonic Or Telehealth Conversations Billable Under These Codes?
Are There Documentation Requirements?
Can The ACP Codes Be Used With Other Evaluation And Management (E/M) Codes?
Did CMS Provide Any Case Examples?
Will Other Payers, Besides Medicare, Use These Codes And Pay For ACP Services?
Need to learn how to bill for advance care planning conversations? Billing for Advance Care Planning Conversations is a course co-created by the CSU Institute for Palliative Care and the Coalition for Compassionate Care of California. Individuals and organizations will learn about the new codes and explore through case scenarios how to accurately bill Medicare for advance care planning discussions.
Note: These FAQs are provided to assist our members in understanding the new advance care planning billing codes. While we make every effort to ensure our information is accurate, staff at the Coalition for Compassionate Care of California are not Medicare billing experts. If you have detailed questions please consult with your own billing department.