Advanced Care Planning Billing and Reimbursement

Many providers are not familiar with these codes and are missing out on the
reimbursement for these services. Let me explain services provided in order
to bill for these codes. The provider discusses and shares planning for the
future health care needs of the patient including Advance Directives. Examples
of written Advance Directives would include but not limited to are Health Care
Proxy, Durable Power of Attorney for Health Care, Living Will, or Medical Orders
for Life-Sustaining Treatment (MOLST). This discussion is typically 30 minutes
with the patient, his family, or someone representing the patient. Advanced care
planning focuses on the patient and involves both the patient and the provider
responsible for their care. It empowers the patient to make an informative decision
about their future care including their advanced care decisions. This gives
the patient the opportunity to express their preference for care depending on their
current and future health status and treatment options available. The provider may
enter the actual plan on forms specifically designed for that purpose in the
patients record.

There are two CPT codes for Advanced Care Planning, 99497 which are used for up
to a 30 minute discussion, and 99498 which is an add on code for each additional
30 minutes of the discussion. These codes can be billed at the same time as other
medical services taking place at the same visit before or after the time spent
on advanced care planning. Don’t forget to add a 25 modifier to the office visit
code. The 2017 Medicare allowed reimbursement amounts are 99497 $88.15
and 99498 $76.60.

I am certain many of you have provided these services to your patients and just
bundled it into the office visit code and losing out on and additional
$88-$164.00 per encounter. Add these codes to your superbill and your EMR
templates so they are not forgotten!

As always, Take Advantage for all of your outsourced medical billing needs!