Advance Care Planning

Using the CPT (current procedural terminology) description, there are two codes for advance care planning (ACP).

“99497 and 99498 are used to report the face-to-face services between a physician or other qualified health care professional and a patient, family member or surrogate in counseling and discussing advance directives, with or without completing relevant legal forms.”

According to the CPT manual, advance care planning involves the explanation and discussion of advanced directives; this document appoints an agent and/or records the wishes of the patient pertaining to his/her medical treatment at a future time should he/she lack decisional capacity at that time.  Examples of such forms include a Health Care Proxy, Durable Power of Attorney for healthcare, a Living Will, Physician Orders for Life Sustaining Treatment (POLST), or Medical Order for Life Sustaining Treatment (MOLST).

In the final CY 2026 Physician Fee Schedule, the work RVU for 99497 (first 30 minutes) is 1.50 and 99498 (each additional 30 minutes is 1.40).

There is no specific training, specialty restrictions, or quality measures a provider must satisfy to perform and bill for ACP. 

Not necessarily. If the patient is unable to participate in the conversation due to medical illness or lack of capacity, the health care provider can engage with a family member or surrogate, so long as the discussion is face-to-face.

According to CMS, your documentation of the ACP discussion should include:

● The fact that the visit was voluntary 

● An explanation of advance directives 

● Who was present 

● The time spent discussing ACP during the face-to-face encounter 

Completion of specific forms, such as, MOLST, DNR, Living Will, or other standard forms is not required to bill for the service. (Advance Care Planning, Medicare Learning Network, MLN909289, March 2025.)

Yes.  The first code, 99497, covers the first 30 minutes of face-to-face conversation and documentation by the provider with the patient, family member(s) and/or surrogate.  In order to qualify, at least 16 minutes must be performed and documented.  Should you exceed 30 minutes, which is less likely in the ED setting, there is a second code, 99498, which includes each additional 30-minute increments of service.  However, CPT requires that no active management of the problem(s) can be undertaken during the time period reported. When you perform another service concurrently as a time based service, CMS requires that you do not include the time spent on the concurrent service with the time based service.

The Advance Care Planning codes do appear in Appendix P of CPT and on the CY 2026 CMS (Medicare) lists meaning that they may be reported via telehealth with a -95 modifier. Be sure to check local payer policy on reimbursement policies. Additionally watch congressional action regarding Medicare patients and waivers for patient and clinician location, which as date of this review continue to be a waived requirement. See the Telemedicine FAQ for further details.

CPT allows the ACP and E/M code to be billed in addition to a broad range of other E/M service codes. For the Emergency Provider, this service can be reported together with the Emergency Department E/M’s (99281-99285) and all the observation codes. ACP cannot, however, be reported with critical care services, 99291.

No, there are no limits on the number of times ACP can be used for a given beneficiary in a given period of time; however,  CMS states in their MLN: 

“If you bill these services more than once, document a change in the patient’s health status or wishes about end-of-life care in their medical record.” (Advance Care Planning, Medicare Learning Network, MLN909289, March 2025.)

Advance Care Planning is an established CPT code.  Therefore, technically any payer that professes to accept CPT coding current to the date of service ought to accept these codes, unless expressly stating otherwise or publishing other restrictions.

As of January 2016, and currently, the National Correct Coding Initiative (NCCI) –one of the major underpinnings supporting Medicare coding-- indicated that the ACP codes are reportable.  So the status indicator for both codes is “A,” meaning it is an active code the Medicare physician fee schedule.   As yet, there are no Medicare National Coverage Determinations for the ACPs, so it is possible that local Medicare contractors could make their own determinations.