Final rule, CMS is allowing ACP w/ AWV - Modifier 33
For the first 30 mins or less capture 99497
For advanced care planning beyond an initial 30 minutes capture 99498+ in addition to 99497.
In this procedure, the provider discusses and shares planning with a patient, his family, or an individual representing the patient, regarding the future health care needs of the patient. Use this code for the
first 30 minutes of face to face time that the provider spends.
Clinical Responsibility
The provider discusses and shares advance care planning for
up to 30 minutes with a patient, his family, or an individual representing the patient, regarding the future healthcare needs of the patient.
Annual Wellness Visit
In the final rule, CMS is allowing ACP as a voluntary, separately payable element of the Medicare
patient’s Annual Wellness Visit (AWV), at the beneficiary’s discretion. When ACP is furnished as an
optional element of the AWV as a part of the same visit with the same date of service, the CPT codes
99497 and 99498 “should be reported and will be payable in full in addition to the payment that is
made for the AWV.” ACP services provided in conjunction with the AWV should be reported with
modifier -33. There will be no Part B coinsurance or deductible since it is connected to the AWV,
which requires no cost sharing.
CMS states that the “current regulations for the AWV allow the AWV to be furnished under a team
approach by physicians or other health professionals under the physician’s direct supervision.”
https://www.caredimensions.org/userf...ule_110215.pdf
CMS has not developed a national coverage determination. Individual Medicare Administrative Contractors will develop their own policies. CMS hasn’t placed frequency limits on the service, realizing that as a patient’s condition changes, the physician and patient and family may need to re-discuss these critical issues. There is not a limit on the specialty designation of the physician or NPP who provides the service. The service may be performed in an RHC or an FQHC, but those centers will be paid their all-inclusive rate for a visit, and won’t receive any additional payment. A Medicare patient will be responsible for a co-pay and deductible for the service, unless it is performed on the same day as a wellness visit, (G0438 or G0439). In that case, append modifier 33 to the ACP code and the patient will not be charged a co-pay or deductible. Document the time spent in the discussion (exclusive of other E/M services that day) in the medical record.
http://nicolettinotes.com/2015/12/02...g-99497-99498/
Every article I found states that CMS is currently working on NCD for 99497 and 99498.
http://www.aafp.org/news/government-...vancecare.html
http://www.nahc.org/NAHCReport/nr151113_1/
