Did you know Advance Care Planning is considered as an optional element of an Annual Wellness Visit?
Medicare covers advance care planning (ACP) as a separate service when provided by physicians and other health professionals (such as nurse practitioners who bill Medicare using the physician fee schedule) since Jan. 1 2016. The Centers for Medicare & Medicaid Services (CMS) made the Current Procedural Terminology (CPT) codes for Advanced Care Planning separately payable for Medicare. The change in policy will be implemented through the annual Medicare Physician Fee Schedule Database (MPFSDB) update. In addition, The Centers of Medicare and Medicaid Service is also including voluntary Advanced Care Planning as an optional element of the Annual Wellness Visit. Advanced Care Planning services furnished on the same day and by the same provider as an Annual Wellness Visit are considered a preventive service. Therefore, the deductible and coinsurance are not applied to the codes used to report ACP services when performed as part of an Annual Wellness Visit.
Voluntary Advanced Care Planning means the face-to-face service between a physician or other qualified health care professional and the patient discussing advance directives, with or without completing relevant legal forms. An advance directive is 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.
As Per CMS, Advanced Care Planning may be reported, ?When the described service is reasonable and necessary for the diagnosis or treatment of illness or injury.?
The American Medical Association introduced two new advance care planning codes in CPT(R) 2015:
- 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.
- +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).
Effective January 1, 2016, when Advanced Care Planning services are provided as a part of an Annual Wellness Visit, practitioners would report CPT code 99497 (plus add-on code 99498 for each additional 30 minutes, if applicable) for the Advanced Care Planning services in addition to either of the Annual Wellness Visit codes G0438 and G0439. CPT codes 99497 and 99498 used to describe Advanced Care Planning are separately payable under the Medicare Physician Fee Schedule (MPFS). When voluntary Advanced Care Planning services are furnished as a part of an Annual Wellness Visit, the coinsurance and deductible would not be applied for Advanced Care Planning. Under that circumstance, both the Advanced Care Planning and Annual Wellness Visit must also be billed together on the same claim. In order to have the deductible and coinsurance waived for Advanced Care Planning when performed with an Annual Wellness Visit, the Advanced Care Planning code(s) must be billed with modifier 33 (Preventive services). Since payment for an Annual Wellness Visit is limited to only once a year, the deductible and coinsurance for Advanced Care Planning billed with an Annual Wellness Visit can only be waived once a year.