wynonna
True Blue
Does it have to be an MD, DO, PA, or APRN nurse practitioner who does Advanced Care Planning (MOLST form) or can it be an RN or LPN?
Who can bill a 99497-99498?
Thank you
Who can bill a 99497-99498?
Thank you
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Wiki Who can perform advanced Care Planning?
- Thread starter wynonna
- Start date
Pathos
True Blue
Per CMS:
"ACP services may be billed by physicians and non-physician practitioners (NPPs) whose scope of practice and Medicare benefit category include the services described by the CPT codes above. They may also be billed by hospitals."
Here's also a newish (2016) FAQ on billing and the PFS for Advanced Care Plan:
"As we said in the CY 2016 FPS final rule (80 Fed. Reg. 70956), the services described by CPT codes 99497 and 99498 are appropriately provided by physicians or using a team-based approach provided by physicians, nonphysician practitioners (NPPs) and other staff under the order and medical management of the beneficiary’s treating physician. The CPT code descriptors describe the services as furnished by physicians or other qualified health professionals, which for Medicare purposes is consistent with allowing these codes to be billed by the physicians and NPPs whose scope of practice and Medicare benefit category include the services described by the CPT codes and who are authorized to independently bill Medicare for those services. Therefore, only these practitioners may report CPT codes 99497 or 99498. The ACP services described by these codes are primarily the provenance of patients and physicians; accordingly we expect the billing physician or NPP to manage, participate and meaningfully contribute to the provision of the services in addition to providing a minimum of direct supervision. The usual PFS payment rules regarding ‘‘incident to’’ services apply, so that when the services are furnished incident to the billing physician or practitioner all applicable state law and scope of practice requirements must be met and there must be a minimum of direct supervision in addition to other incident to rules. "
Per AAFP:
Health Care Professionals Who May Furnish and Bill ACP:
Non-physicians must legally be authorized and qualified to provide ACP in the state in which the services are furnished.
So what I am reading is that Advanced Care Plan (ACP) should be performed by physicians (MDs/DOs) or NPPs (PAs, NPs, CNSs), unless your state specifically allows RNs/LPNs to perform ACPs. I looked at "Incident-to", and this pertains mainly to NPPs unless the ACP is within the RN's or LPN's scope of practice. Note that billing "Incident-to" also add a whole new layer of requirements.
"ACP services may be billed by physicians and non-physician practitioners (NPPs) whose scope of practice and Medicare benefit category include the services described by the CPT codes above. They may also be billed by hospitals."
Here's also a newish (2016) FAQ on billing and the PFS for Advanced Care Plan:
"As we said in the CY 2016 FPS final rule (80 Fed. Reg. 70956), the services described by CPT codes 99497 and 99498 are appropriately provided by physicians or using a team-based approach provided by physicians, nonphysician practitioners (NPPs) and other staff under the order and medical management of the beneficiary’s treating physician. The CPT code descriptors describe the services as furnished by physicians or other qualified health professionals, which for Medicare purposes is consistent with allowing these codes to be billed by the physicians and NPPs whose scope of practice and Medicare benefit category include the services described by the CPT codes and who are authorized to independently bill Medicare for those services. Therefore, only these practitioners may report CPT codes 99497 or 99498. The ACP services described by these codes are primarily the provenance of patients and physicians; accordingly we expect the billing physician or NPP to manage, participate and meaningfully contribute to the provision of the services in addition to providing a minimum of direct supervision. The usual PFS payment rules regarding ‘‘incident to’’ services apply, so that when the services are furnished incident to the billing physician or practitioner all applicable state law and scope of practice requirements must be met and there must be a minimum of direct supervision in addition to other incident to rules. "
Per AAFP:
Health Care Professionals Who May Furnish and Bill ACP:
- Physicians (any specialty)
- Clinical nurse specialist (CNS)
- Nurse practitioners (NPs)
- Physician assistants (PAs)
Non-physicians must legally be authorized and qualified to provide ACP in the state in which the services are furnished.
So what I am reading is that Advanced Care Plan (ACP) should be performed by physicians (MDs/DOs) or NPPs (PAs, NPs, CNSs), unless your state specifically allows RNs/LPNs to perform ACPs. I looked at "Incident-to", and this pertains mainly to NPPs unless the ACP is within the RN's or LPN's scope of practice. Note that billing "Incident-to" also add a whole new layer of requirements.