Advance Care Planning Software: 99497, 99498

Q: Who qualifies for Advance Care Planning (ACP)?

The discussion is voluntary: the patient (or surrogate) was offered it and agreed, and could have declined. The billing practitioner personally held the face-to-face discussion — a physician, nurse practitioner, physician assistant or clinical nurse specialist. willowbridge counts only the practitioner's own ACP time (the same as Medicare's CY 2027 proposal); a navigator offers and schedules it. No care plan, initiating visit or written consent is required. The claim carries the condition discussed, or an administrative examination code (Z02.89) when none was. In person, by video, or audio only to a patient at home who could not use, or did not agree to, video (modifier 93). A repeat discussion needs a documented change in the patient's health or wishes since the last one; there is no frequency limit. ACP may be billed alongside care management (CCM, PCM, APCM, BHI, CHI, PIN, CPM, RPM, TCM, home health oversight) — the same minutes never count twice. A few codes never go on the same date as ACP (critical care, 99483, some psychiatric codes, 99091, 98975). Cost sharing: Part B coinsurance and deductible apply, except when it is held the same day as an AWV and billed with it (modifier 33). Modifier 25 is not needed on a same-day office visit only because ACP was billed.

Programs / ACP

Advance Care Planning

ACP Period: Per discussion, on its date (time-based) Source: CMS-1832-F (CY 2026 PFS Final Rule)

What it is

Advance Care Planning (ACP) is a voluntary, face-to-face discussion between the practitioner and the patient, family member or surrogate about the patient's wishes for future care: explaining advance directives — a living will, a health care proxy, your state's POLST, MOLST or MOST form — with any form completed when the patient wants to. Completing a form is not required to bill.

ACP is billed per discussion, on the date it was held, under the practitioner who held it — not by the month. In willowbridge each discussion is recorded on the chart's Advance care plan card (or in the care app) as an ACP session: the date and times, who took part, how and where, that it was voluntary and advance directives were explained, and the condition discussed. There is no ACP enrollment and no ACP timer. Each discussion freezes on its own the day after it was held and goes to the practitioner for sign-off; a record that is missing something holds — and says what — instead of being lost.

Held the same day as an Annual Wellness Visit, by the same practitioner and as part of it, the discussion goes on that visit's claim with modifier 33 and the patient pays no coinsurance or deductible for it, once a year; willowbridge then files no ACP claim of its own and the signed note tells the practice what to code. When athena already holds the patient's directive, POLST or MOST form, proxy or a discussion it billed, the care team marks ACP is in athena — nothing is re-done, re-uploaded or billed twice. The worklist asks navigators to offer and schedule ACP (voluntary) and practitioners to offer it at the next visit, from the last discussion and the practice's offer interval.

Who qualifies

The discussion is voluntary: the patient (or surrogate) was offered it and agreed, and could have declined.
The billing practitioner personally held the face-to-face discussion — a physician, nurse practitioner, physician assistant or clinical nurse specialist. willowbridge counts only the practitioner's own ACP time (the same as Medicare's CY 2027 proposal); a navigator offers and schedules it.
No care plan, initiating visit or written consent is required. The claim carries the condition discussed, or an administrative examination code (Z02.89) when none was.
In person, by video, or audio only to a patient at home who could not use, or did not agree to, video (modifier 93).
A repeat discussion needs a documented change in the patient's health or wishes since the last one; there is no frequency limit.
ACP may be billed alongside care management (CCM, PCM, APCM, BHI, CHI, PIN, CPM, RPM, TCM, home health oversight) — the same minutes never count twice. A few codes never go on the same date as ACP (critical care, 99483, some psychiatric codes, 99091, 98975).
Cost sharing: Part B coinsurance and deductible apply, except when it is held the same day as an AWV and billed with it (modifier 33). Modifier 25 is not needed on a same-day office visit only because ACP was billed.

Codes & when to bill them

How the minutes add upEach discussion bills on its own date, under the practitioner who held it. Bill 99497 once the practitioner's own advance care planning time passes the midpoint of the first 30 minutes, at 16 minutes; add a 99498 at 46, a second at 76 and a third at 106 minutes — Medicare's daily limit. Minutes from different days never add up. Held the same day as an Annual Wellness Visit, by the same practitioner and as part of it, it goes on that visit's claim with modifier 33.

Each billable code, with the requirements that must be on file to bill it.

99497Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; first 30 minutes, face-to-face with the patient, family member(s), and/or surrogate.

RequirementsOne discussion, on its date, by the practitioner who held it; at least 16 minutes of ACP-only time; voluntary; advance directives explained. Modifier 33 when held the same day as an AWV (on that visit's claim); 93 audio only.
99498Advance care planning; each additional 30 minutes (list separately in addition to 99497).

RequirementsAdd-on to 99497 on the same date: one at 46 minutes, a second at 76, a third at 106 (Medicare's daily limit is three).

Documentation required every cycle

Each discussion is recorded as an ACP session showing:

Voluntary: the patient (or surrogate) was offered the discussion and accepted it.
Advance directives explained.
Who took part, with their relationship — and why the patient was not, if they weren't.
The date, start and length of the ACP-only time.
How and where: in person, video or audio only, and where the patient was (the claim's place of service).
The condition discussed (the claim's diagnosis).
On a repeat discussion, what changed since the last one.
Any form completed (optional), and the practitioner's sign-off that they held it personally, it was voluntary, and the minutes are ACP only.

Built-in patient consentwillowbridge exclusive

Every program ships with compliant, CY-2026 patient consent language — read verbatim into the in-app consent capture flow, captured with date + modality, and version-pinned to each claim, so the consent on file always matches the consent that was billed. No more chasing signatures or re-papering when the rule changes.

Common questions

Who qualifies for Advance Care Planning (ACP)?

The discussion is voluntary: the patient (or surrogate) was offered it and agreed, and could have declined. The billing practitioner personally held the face-to-face discussion — a physician, nurse practitioner, physician assistant or clinical nurse specialist. willowbridge counts only the practitioner's own ACP time (the same as Medicare's CY 2027 proposal); a navigator offers and schedules it. No care plan, initiating visit or written consent is required. The claim carries the condition discussed, or an administrative examination code (Z02.89) when none was. In person, by video, or audio only to a patient at home who could not use, or did not agree to, video (modifier 93). A repeat discussion needs a documented change in the patient's health or wishes since the last one; there is no frequency limit. ACP may be billed alongside care management (CCM, PCM, APCM, BHI, CHI, PIN, CPM, RPM, TCM, home health oversight) — the same minutes never count twice. A few codes never go on the same date as ACP (critical care, 99483, some psychiatric codes, 99091, 98975). Cost sharing: Part B coinsurance and deductible apply, except when it is held the same day as an AWV and billed with it (modifier 33). Modifier 25 is not needed on a same-day office visit only because ACP was billed.

Which codes does willowbridge bill for ACP, and when?

Each discussion bills on its own date, under the practitioner who held it. Bill 99497 once the practitioner's own advance care planning time passes the midpoint of the first 30 minutes, at 16 minutes; add a 99498 at 46, a second at 76 and a third at 106 minutes — Medicare's daily limit. Minutes from different days never add up. Held the same day as an Annual Wellness Visit, by the same practitioner and as part of it, it goes on that visit's claim with modifier 33.

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