.jpg "Daniel Godla")
Advance Care Planning (ACP), has been updated by CMS for 2026 and they have made significant increases to reimbursement! In this video, we’ll discuss everything you need to know so that you can properly code and bill for this service.
Make sure to download a guide to the 2026 ACP CPT Codes.
This year, there are no major changes to the Advance Care Planning rules and regulations, but there has been a nearly 10% increase to its reimbursement rates.
Keep in mind that the reimbursement rates are based on national averages, which may vary in your area. For the exact current rate based on your location, visit the Physician Fee Schedule website.
With the rate increases, now is a great time to start offering Advance Care Planning, especially during an Annual Wellness Visit. If completed during an Initial or Subsequent AWV, Advance Care Planning is fully covered for patients under Medicare Part B.
ACP CPT Code 99497
First is CPT Code 99497 for 30 minutes of face-to-face consultation with the patient, their family, and/or a surrogate with a minimum of 16 minutes of service time documented. This must be provided by a physician or other qualified healthcare professional.
The service time must include an explanation and review of advance care directives and options for completing them. The documentation should record that the ACP conversation was voluntary on behalf of the patient, describe what was talked about, who was present for the conversation, and note the length of time for the consultation. It is not required to complete an advance care directive during the discussion. Completion is only required if you’ve noted in your documentation that you’ve performed this task.
The current national average reimbursement rate for code 99497 is $87, which is up over 7 dollars from last year.
ACP Add-on Code 99498
There is an add-on billing code, 99498 for an additional 30 minutes of ACP services. You must list this billing claim separately, in addition to the code for the primary consultation. Also, be sure that a minimum of 16 minutes past the first 30 minutes is documented using the same requirements as code 99497.
The current national average reimbursement rate for 99498 is $78, which is up over 9 dollars from last year!
If you’d like to learn more about offering this valuable service at your practice, reach out to us here at ThoroughCare and we can help.
