BILLING CPT CODE 99497

Why This Topic Matters

Billing rules for advance care planning can affect whether a claim is paid separately, bundled, or treated as preventive care. Understanding the CMS policy context helps practices align documentation and claim submission with Medicare requirements.

Article Sections

1. CMS policy update and implementation

   Introduces the CMS guidance, related MLN Matters material, and the timing of the policy update. This section frames the Medicare payment context for advance care planning services.

2. Advance care planning under OPPS

   Summarizes how the service is treated when billed in connection with other outpatient services versus when it is the only service. The section focuses on the payment framework discussed by CMS.

3. Advance care planning with the Annual Wellness Visit

   Covers the relationship between voluntary advance care planning and the Annual Wellness Visit. It describes the general Medicare billing context when both services are furnished together.

4. Voluntary ACP and reporting context

   Defines the general concept of voluntary advance care planning and explains its role as an optional element of the Annual Wellness Visit. This section also notes the broader reporting context referenced by CMS.