Part of Annual Wellness Visit
CPT 99497: Advance Care Planning, first 30 minutes
Face-to-face discussion of advance directives with the patient, family member, or surrogate, with or without completing relevant legal forms.
Time threshold & code combinations
Reportable once at least 16 minutes of a face-to-face advance care planning discussion have occurred; the full code covers up to 30 minutes.
- 99498 is the add-on for each additional 30 minutes
- Can be billed on the same day as an AWV (G0438/G0439) or as a standalone service on any date
Who can bill
- Physicians
- Non-physician practitioners who can bill E/M services
Eligibility & billing requirements
- Patient (or their family/surrogate) voluntarily agrees to discuss advance directives
- No specific diagnosis is required
- Face-to-face discussion of advance directives, healthcare proxies, and/or completion of relevant forms
- Part B deductible/coinsurance is waived, once per calendar year, only when furnished by the same practitioner as the AWV, billed on the same claim as the AWV, and reported with modifier 33; standard cost-sharing applies otherwise
When to use it
Advance directive discussion during the AWV
During a subsequent AWV, the provider spends 30 minutes discussing the patient's wishes for future medical care and healthcare proxy designation.
Billing: G0439 + 99497
Standalone advance care planning visit
A patient schedules a dedicated visit to discuss and complete an advance directive with their physician, unrelated to any wellness visit.
Billing: 99497 (standard Part B cost-sharing applies)
Documentation checklist
- Time spent in the discussion
- Summary of the advance directive discussion
- Note on whether it was furnished same-day as an AWV
Common billing mistakes
- Not documenting time separately from the AWV's own service elements
- Assuming Advance Care Planning is cost-sharing-exempt in every circumstance, the waiver only applies once per year, and only when it's billed on the same claim as the AWV with modifier 33