Awareness : OBC Tips

Advanced Care Planning Codes 99497 and 99498

Beginning in calendar year (CY) 2016, CPT codes 99497 and 99498 used to describe Advance Care Planning (ACP) will be separately billable.

In addition, for dates of service on or after January 1, 2016, the coinsurance and deductible do not apply for voluntary ACP performed on the same day and by the same provider as a covered Annual Wellness Visit (AWV).  Both the ACP and AWV must also be billed together on the same claim. In order to have the deductible and coinsurance waived for ACP when performed with an AWV, the ACP code(s) must be billed with modifier 33 (Preventive services). Since payment for an AWV is limited to only once a year, the deductible and coinsurance for ACP billed with an AWV can only be waived once a year.