Table 2.

Ten Tips for Compliant Use of ACP Codes for Medicare Patients

1.	Medicare has adopted CPT® codes 99497 and 99498 to reimburse for ACP and will utilize CPTs broad definition of ACP.
2.	A successful ACP bill does not require completion of a formal Advance Directive, Healthcare Power of Attorney, or Physician/Medical Orders for Scope of Treatment form.
3.	ACP is reimbursable when performed by a physician or qualified health professional, defined as a nonphysician provider, including nurse practitioners, physician assistants, and clinical nurse specialists.
4.	ACP discussions held by other members of the healthcare team are reimbursable if performed “incident to” the services of a billing practitioner, including a minimum of direct supervision.
5.	ACP codes may be billed on the same day/during the same visit as an Evaluation and Management code, with the exception of critical care codes, or they may be billed as stand-alone codes.
6.	ACP codes may be used in the inpatient, outpatient, skilled nursing facility, and home settings but not during telehealth or phone-based visits.
7.	Patients should be informed that Part B cost sharing under Medicare is in effect and be given the opportunity to refuse ACP services.
8.	While CMS has authorized payment for ACP using ACP codes 99497 and 99498, the ultimate decision to pay providers will be made at the Medicare Administrative Contractor level.
9.	ACP codes may be billed as often as every day and may be billed for patients who have elected the Medicare Hospice Benefit.
10.	ACP codes can be used in addition to transitional care management and chronic care management codes and within global surgical periods.

CMS, Centers for Medicare and Medicaid Services.