CPT^® 99497, Under Advance Care Planning

The Current Procedural Terminology (CPT^®) code 99497 as maintained by American Medical Association, is a medical procedural code under the range - Advance Care Planning.

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Summary

The provider discusses and shares planning with a patient, his family, or an individual representing the patient, regarding the future health care needs of the patient. Use this code for the first 30 minutes of face to face time that the provider spends.

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Modifiers for G0439, 99215 and 99498

99498 shouldn't be used without first using 99497. 99497 is for the first 30 minutes, 99498 is each additional 30 minutes.... [ Read More ]

Modifier 25 with 99223 and 99497

Based on NCCI guidelines, modifier 25 would be appended to CPT 99497 when reported with 99223 when appropriate. For this NCCI edit pair, CPT 99223 is the column 1 code and 99497 is the column 2 code.... [ Read More ]

99497-33 Denial

[QUOTE="lvatauchi, post: 506973, member: 489996"] Hello, everybody. I coded as below for pt. who has BCBS State Health Plan , secondary is Medicare and 99497-33 got denied by both insurance. Did I mis... [ Read More ]

99497/99498 Advanced Care Planning

[QUOTE="njycarter17, post: 506894, member: 732540"] [ATTACH type="full" alt="1644241319728.png"]5688[/ATTACH] [ATTACH type="full" alt="1644241379891.png"]5689[/ATTACH] It looks like 99221-99223 - 994... [ Read More ]

99497-33 Denial denial

Hello, everybody. I coded as below for pt. who has BCBS State Health Plan , secondary is Medicare and 99497-33 got denied by both insurance. Did I miss modifier? Spoke to BCBS Rep and was explained th... [ Read More ]

99497/99498 Advanced Care Planning

[QUOTE="nlbarnes, post: 506536, member: 53490"] Can you bill 99497/99498 in the inpatient setting (99221 - 99233 or 99291/99292)? [/QUOTE] [ATTACH type="full"]5688[/ATTACH] [ATTACH type="full"]5689[/... [ Read More ]

99497/99498 Advanced Care Planning

Can you bill 99497/99498 in the inpatient setting (99221 - 99233 or 99291/99292)?... [ Read More ]

Place of Service with Medicare AWV

If you’re seeing a high number of denials for Medicare annual wellness visits (AWVs), you’re not alone. Identifying whether to code for an Initial Preventive Physical Exam (IPPE, or the “Welcome... [ Read More ]

99443 Telephone evaluation and management with Non face-to-face prolonged services (CPT codes 99358‒99359)

[QUOTE="marandee, post: 498068, member: 94190"] [LIST] [*]CMS has also included [B]CPT codes 99354-99355/99356-99357 [/B]Prolonged Services for Office/Inpatient and [B]CPT codes 99497-99498 [/B]Advan... [ Read More ]

AWV

We bill a lot of AWV, ACP, and majority of the time also a separate E&M code level (with modifier 25) provided on the same day. We bill 99497-33 DX: Z71.89 as this is billable once per year. We are... [ Read More ]

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