What is the CPT code for advance care planning in Medicare?

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The primary CPT codes for advance care planning (ACP) in Medicare are 99497 and 99498:

  • CPT 99497: Covers the first 30 minutes (requires a minimum of 16 minutes documented) of a face-to-face advance care planning discussion with the patient, family member(s), and/or surrogate by a physician or other qualified health care professional.
  • CPT 99498: An add-on code for each additional 30 minutes (requires at least 16 minutes into the additional block, or 46+ minutes total). Must be billed in conjunction with code 99497.

Key Billing and Coverage Details

  • Eligible Providers: Physicians (MD/DO), nurse practitioners, physician assistants, and clinical nurse specialists. (Registered nurses and social workers can assist under supervision, but cannot bill independently).
  • Annual Wellness Visit (AWV): When billed on the same day and with the same provider as an Annual Wellness Visit (using modifier -33 or specific AWV codes like G0438 or G0439), Medicare waives the coinsurance and Part B deductible, making it a zero out-of-pocket cost for the patient.
  • Documentation Requirements: You must document the voluntary nature of the encounter, the exact face-to-face time spent, the names and relationships of the participants, and the content of the discussion and/or advance directives completed.

You can review official guidelines through the CMS Advance Care Planning Fact Sheet or the American Academy of Family Physicians (AAFP) Guide.

Is there a CPT code for advanced care planning?

Yes, there are two specific CPT codes for advanced care planning (ACP) services.

CPT Codes for Advanced Care Planning

  • 99497: First 30 minutes of face-to-face service (requires a minimum of 16 minutes documented).
  • 99498: Each additional 30 minutes of face-to-face service, listed separately as an add-on code.

Key Details

Is advance care planning covered by Medicare?

Yes, Medicare Part B covers voluntary advance care planning discussions between you and your doctor or other qualified health provider. You can review official details directly on Medicare Coverage of Advance Care Planning.

Coverage and Cost Details

  • Cost during Annual Wellness Visit: You pay $0 if you have your advance care planning done during your "Welcome to Medicare" or annual wellness visit, provided your doctor accepts assignment.
  • Cost during regular visits: If you have the discussion during a general medical visit or outside your annual wellness visit, standard Part B deductibles and 20% coinsurance apply.
  • Frequency: Medicare places no hard limit on how often you can have or bill for these sessions, as long as it is medically necessary and your health status or end-of-life wishes change.

What is Included

  • Discussions: A face-to-face talk about your future medical care wishes if you become unable to speak or make decisions for yourself.
  • Legal paperwork: Help with preparing or reviewing advance directives, such as a living will or naming a healthcare proxy (durable power of attorney).

How do you bill for advance care planning?

You bill for advance care planning (ACP) using specific time-based CPT codes during face-to-face sessions with a patient, family member, or surrogate.

CPT Codes and Time Requirements

  • 99497: Covers the first 30 minutes of service, requiring a minimum of 16 minutes of documented face-to-face time.
  • 99498: Used as an add-on code for each additional 30 minutes, requiring at least 16 minutes past the initial 30 minutes (46+ total minutes). Discussions lasting 15 minutes or less cannot be billed as ACP.

Eligible Providers

  • Qualified Health Professionals: Physicians (MD/DO), nurse practitioners, physician assistants, and clinical nurse specialists can independently bill these codes.
  • Support Staff: Registered nurses, social workers, and care coordinators may assist under direct supervision, but the billing provider must be actively involved.

Billing and Coverage Rules

  • Annual Wellness Visit (AWV): You can include ACP during an initial or subsequent AWV at no out-of-pocket cost to the patient by adding Modifier -33.
  • Standalone or E/M Visits: ACP can be billed alongside standard Evaluation and Management (E/M) visits. If billed during the same encounter, make sure not to double-count time if the E/M code is also time-based. Standard deductibles and coinsurance apply outside of the AWV.

Documentation Requirements

  • Record the exact start and end times or total duration of the face-to-face discussion.
  • Note that patient participation was voluntary.
  • List the names and relationships of all attendees present.
  • Summarize the advance directives or end-of-life treatment choices explained during the session.

How often can advance care planning be billed?

You can bill for advance care planning as often as medically necessary, as Medicare and most payers have no strict frequency limits or caps on how many times these services can be reported for a patient.

Frequency and Billing Rules

  • No official limits: The Centers for Medicare and Medicaid Services (CMS) does not set a maximum number of times you can bill for advance care planning (ACP) per year or lifetime.
  • Expectation of change: When you bill ACP multiple times for the same patient, medical records should show a documented change in the patient's health status, a new diagnosis, or an updated shift in their personal wishes or goals of care.
  • Time requirements: You must spend at least 16 face-to-face minutes to bill the base code, and subsequent time blocks can use add-on codes.

2026 Advance Care Planning CPT Codes! All Updates You Need To Know!

9 related questions found

What is advance care planning?

Advance care planning is an ongoing process of discussing, sharing, and writing down your values and choices for future medical care if you ever become unable to speak or make decisions for yourself.

You can read detailed guides and recommendations from the National Institute on Aging and UCLA Health to better understand how this process works. For a clinical perspective, see the review on Advance Care Planning: What, When, and How? on PubMed Central.

Core Goals

  • Respect your wishes: Ensure doctors and family know what treatments you want or do not want.
  • Relieve stress: Prevent family members from guessing your medical choices during a crisis.
  • Empower your choice: Apply to adults of any age, not just older adults or people who are sick.

Main Documents Involved

  • Health Care Proxy (Durable Power of Attorney): A legal paper naming a trusted person to make medical choices for you if you cannot.
  • Living Will: A written guide stating specific treatments you want or reject, such as breathing machines or tube feeding.
  • Medical Orders (POLST / DNR): Specific doctor-signed orders for emergency care, like do-not-resuscitate instructions.

Steps in the Process

  1. Reflect: Think about your personal values and what quality of life means to you.
  2. Talk: Discuss your thoughts with your doctor, family, and chosen proxy.
  3. Document: Fill out legal forms that match your state or country rules.
  4. Update: Review your choices every year or whenever your health changes.

What is the ICD-10 code for Advanced Care Planning?

There is no specific standalone ICD-10-CM diagnosis code exclusively for advance care planning (ACP), but Z71.89 (Other specified counseling) is most commonly used for general ACP counseling.

Commonly Used ICD-10 Codes for ACP Contexts

  • Z71.89: Other specified counseling (broadly used for general ACP discussions)
  • Z51.5: Encounter for palliative care (used when ACP occurs in a palliative care setting)
  • Z66: Do not resuscitate (DNR) status (used when the discussion documents DNR orders)
  • Active Chronic Condition Code: (e.g., heart failure, COPD, cancer) reporting the patient's primary diagnosis being managed or discussed during the visit

Key Billing Details

  • Procedure Codes (CPT): Advance care planning is billed using 99497 (first 30 minutes) and 99498 (each additional 30 minutes) rather than an ICD-10 code.
  • Diagnosis Requirement: Medicare does not strictly require a specific ICD-10 diagnosis code to bill for ACP, though pairing a relevant condition or general counseling code helps satisfy claim formatting and payer edits.

What are the billing guidelines for CPT code 99497?

CPT code 99497 covers face-to-face Advance Care Planning (ACP) for the first 30 minutes of discussing advance directives and end-of-life care options.

Time and Duration Rules

  • Minimum Time: You must document at least 16 minutes of face-to-face interaction to bill 99497.
  • Maximum Time: Code 99497 covers up to 45 minutes. Total conversations lasting 46 minutes or more allow you to add the add-on code 99498 for each additional 30 minutes.
  • Unit Limit: Only report one unit of 99497 per date of service.

Eligible Providers and Setting

  • Allowed Providers: Physicians (MD/DO), nurse practitioners, physician assistants, and clinical nurse specialists. Registered nurses and medical assistants cannot independently bill these codes.
  • Setting: Billable in any care setting (outpatient, inpatient, nursing facility, or home).

Documentation Requirements

  • Exact Time: Record the total face-to-face duration in minutes.
  • Participants: List who attended the discussion (patient, family members, or surrogates).
  • Voluntary Nature: Note that the service was voluntary and the patient was given the opportunity to decline.
  • Content: Summarize the topics discussed or forms reviewed, such as living wills or healthcare proxies (completing forms is not required to bill).

Billing and Coinsurance

  • E/M Pairing: You can bill 99497 on the same day as an Evaluation and Management (E/M) service. However, you cannot count the time spent on ACP toward the time required for the separate E/M code.
  • Annual Wellness Visit (AWV): When provided as part of an Annual Wellness Visit (AWV) using modifier -33, Medicare waives patient coinsurance and deductibles. Otherwise, standard Part B cost-sharing applies.

What is the difference between advance care planning and advance directives?

Advance care planning is the ongoing process of discussing and sharing your values and goals for future medical care, while an advance directive is the specific legal document that records those final decisions.

Advance Care Planning

  • The Process: It is a continuous journey of communication involving you, your family, friends, and doctors.
  • The Goal: It helps you explore your personal beliefs and preferences for end-of-life or future medical treatment before a crisis strikes.
  • Flexibility: It can happen at any stage of life and changes as your health or perspective evolves.

Advance Directives

  • The Product: It is the formal, written outcome of that planning.
  • The Legality: It is a legally binding document (sometimes called a living will) that details what treatments you accept or refuse if you lose the capacity to speak for yourself.
  • Decision-Makers: It can formally name a substitute decision-maker to act on your behalf.

For local forms and guidance, you can review the NSW Health Advance Care Planning Toolkit or learn more via Department of Health and Aged Care.

What are the 5 treatments that Medicare won't cover?

Original Medicare does not cover several major healthcare services, most notably routine dental care, hearing aids, routine vision care, long-term custodial care, and overseas medical care.

Major Uncovered Services

  • Routine Dental Care: Original Medicare does not pay for routine cleanings, fillings, tooth extractions, root canals, or dentures, except in rare surgical circumstances related to specific medical treatments.
  • Hearing Aids: Routine hearing tests, hearing aid fittings, and the devices themselves are completely excluded under traditional Medicare.
  • Routine Vision Care: Regular eye exams for prescription glasses, as well as contact lenses and eyeglasses, are not covered (aside from standard lenses after cataract surgery).
  • Long-Term Care: Ongoing custodial care—such as daily help with bathing, dressing, eating, or long-term nursing home stays—is not covered, as Medicare only pays for short-term skilled nursing rehabilitation.
  • Care Outside the United States: Medical treatments and services received while traveling internationally are generally not covered.