Wiki 99223 and 99497

[nishaganesh]

Hey there,

When billing for Part B services in an Inpatient Hospital (POS 21), Skilled Nursing Facility (POS 31), or Nursing Facility (POS 32) setting, and reporting:

1. CPT 99221, 99222, or 99223 with Advance Care Planning (ACP) CPT 99497
2. CPT 99305-99309 with Advance Care Planning (ACP) CPT 99497

To which service should the modifier be appended for Medicare and is it any different for other Payers?

 

[asadiq]

Code (99497 & 99498) may be separately reported when performed on the same date of service in conjunction with the following E/M services: 99201-99215, 99217-99226, 99231-99236, 99238-99239, 99241-99245, 99251-99255, 99281-99285, 99304-99310, 99315-99316, 99318, 99324-99328, 99334-99337, 99341-99345, 99347-99350, 99381-99397, and 99495-99496. Both codes should be reported with modifier-25 added presuming the requirements for use of modifier-25 are met.