Pulmonology Coding Alert

Question: Which settings are eligible to bill for the advanced care planning services? Are there any guidelines as to who is eligible to bill for ACP?

Iowa Subscriber

Answer: There are no place of service limitations on the advanced care planning (ACP), according to CMS. (To read FAQs on ACP, see https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/Downloads/FAQ-Advance-Care-Planning.pdf.)

As stated in CY 2016 PFS final rule (80 Fed. Reg. 70956), “ACP services may be appropriately furnished in a variety of settings depending on the needs and condition of the beneficiary.”

CPT^® codes 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), and 99498 (…each additional 30 minutes [List separately in addition to code for primary procedure]) “are separately payable to the billing physician or practitioner in both facility and non-facility settings and are not limited to particular physician specialties,” CMS clarifies in its FAQs on ACP.