2025 CPT code 99498
(Active) Effective Date: N/A Evaluation and Management - Advance Care Planning Feed
Advance care planning including the explanation and discussion of advance directives, such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; each additional 30 minutes (List separately in addition to code for primary procedure).
Modifiers may be applicable to further specify the circumstances of the service (e.g., modifier 25 for a separately identifiable E/M service on the same day).
Medical necessity is supported by the patient's need to express their wishes regarding future medical care, especially in situations where they may lose decision-making capacity.
The physician or other qualified healthcare professional is responsible for leading the discussion about advance care planning, explaining advance directives, and ensuring the patient's wishes are documented.They must also ensure that the conversation is voluntary and document who is present.
In simple words: This code covers the extra time a doctor or healthcare professional spends talking with you, your family, or someone representing you about your future healthcare wishes, like advance directives, after an initial 30-minute discussion.Each 30-minute block of time beyond that initial conversation is billed separately.
This add-on code is used for each additional 30 minutes of face-to-face time spent by a physician or other qualified healthcare professional with a patient, family member, or surrogate in counseling and discussing advance directives beyond the first 30 minutes (reported with 99497). It includes explaining and discussing advance directives, and may involve completing standard forms.No active management of other medical problems should occur during this time. It can be reported on the same day as other E/M services, except for specific codes like those for critical care or prolonged services.
Example 1: A patient with a newly diagnosed chronic illness spends an hour and 15 minutes discussing advance directives and completing the necessary forms with their physician. 99497 is billed for the first 30 minutes and 99498 is billed once for the additional 45 minutes., A patient's family member meets with the physician for 45 minutes to discuss the patient's advance directives as the patient is incapacitated. 99497 is billed for the first 30 minutes, and no additional code is necessary as the add-on code 99498 is only for time exceeding the initial 30 minutes., A patient nearing the end of life revisits their advance care plan with their physician over multiple sessions.They spend an initial 30 minutes (99497) followed by a 45-minute session a week later (99497 again, because it’s a new session). If the patient's condition changes and there is another hour-long discussion two weeks later, 99497 would be billed for the first 30 minutes and 99498 once for the additional 30 minutes.
Documentation should include: the voluntary nature of the discussion; explanation of advance directives; who was present (patient, family, surrogate); time spent discussing ACP; any changes to health status or wishes; and signed/witnessed advance directive forms, if completed.
- Payment Status: Active
- Specialties:Internal Medicine, Family Medicine, Geriatrics, Oncology, Palliative Care, and other specialties involved in chronic disease management and end-of-life care.
- Place of Service:Office, Inpatient Hospital, Outpatient Hospital, Nursing Facility, Home, and other places where advance care planning discussions occur.