Wiki 99497 and Medicaid

[aleahdraper]

I wanted to see if anyone could help me figure out how to bill advanced care planning with Medicaid. I know that 99497 and 99498 are not covered under Medicaid, but the documentation does not support an inpt em or consult code. I have not had much luck with finding any guidelines for this.

 

[Amy0207]

Could someone please provide any updates on this matter? We handle billing for hospitalists and are experiencing numerous denials from GA Medicaid for CPT code 99497. We typically bill this in conjunction with E/M codes 99222 or 99223. Despite adding modifier 26, the claims are still being denied. Any insights would be greatly appreciated. I am currently a CPC student so any help would be greatly appreciated.