General Question for the Week of April 18, 2016

General Compliance Question of the Week


Last week you said that CPT codes 99497 and 99498 could be assigned for advance care planning codes. These are time-based codes (a base code and an add-on code). Are there minimum amounts of time required to bill these codes?


Here’s what the Centers for Medicare & Medicaid Services (CMS) stated in the 2016 Medicare physician fee schedule final rule when it adopted the CPT codes and CPT provisions regarding the reporting of timed services.

Practitioners should consult CPT provisions regarding minimum time required to report timed services. If the required minimum time is not spent with the beneficiary, family member(s) and/or surrogate to bill CPT codes 99497 or 99498, the practitioner may consider billing a different evaluation and management (E/M) service such as an office visit, provided the requirements for billing the other E/M service are met.

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.