Advanced Care Planning

Table of Contents

• Billing Codes
• Billing Information
• Documentation
• Related Content

[Return to Top]

Billing Codes

• 99497: 30 minutes
• 99498: each additional 30 minutes

[Return to Top]

Billing Information

Medicare waives ACP coinsurance and Part B deductible when ACP is:

• Rendered on the same day as a covered annual wellness visit. (HCPCS codes G0438 or G0439)
• Offered by the same provider as a covered annual wellness visit.
• Billed with modifier 33. (preventive services)

[Return to Top]

Documentation

Documentation to support ACP should include:

• Any change in health status or health care wishes
• Details and discussions, well-being goals, aspirations, needs, self-care, support, test results, summary of diagnosis, medication details and clinical notes
• Explanation of advance directives
• Time spent discussing ACP during face-to-face encounter
• Who was present 

Advance care planning is a preventive service only when its provided in conjunction with an annual wellness visit and reported with modifier 33.

[Return to Top]

Related Content

• Helpful Reminders on Advance Care Planning
• MLN® Fact Sheet: Advance Care Planning
• Advance Care Planning Services FAQs
• Care Management

Revised 7/31/2024