Advance Care Planning

What it is

Advance Care Planning (ACP) is the face-to-face counseling and discussion of advance directives (e.g., a living will, healthcare proxy, POLST/MOLST) between a physician or qualified health professional and the patient, family member, or surrogate. It is voluntary for the patient.

ACP is time-based and billed in 30-minute increments. Per the CPT "more than half" time rule, each unit is reportable once the midpoint of its increment is met: 99497 at ≥ 16 minutes; 99498 at each subsequent 30's midpoint (≥ 46, ≥ 76, …). It may be furnished on the same day as, and in addition to, an E/M visit or the Annual Wellness Visit. Willowbridge tracks each patient's last ACP and flags when a refresh is due.

Who qualifies

• The ACP discussion is voluntary and the patient (or surrogate) agreed to have it.
• A physician or qualified health professional personally furnished the face-to-face discussion.
• Time spent is documented (≥ 16 minutes for the first unit, 99497, per the CPT "more than half" time rule).
• ACP may be billed concurrently with care-management programs (CCM/PCM/APCM/RPM, etc.) — it is a discussion service, not ongoing care management.

Codes & when to bill them

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 by the physician or QHCP; first 30 minutes, face-to-face.
  RequirementsFace-to-face; ≥ 16 minutes (CPT midpoint of the first 30); voluntary discussion documented.
• 99498Advance care planning; each additional 30 minutes (list separately in addition to 99497).
  RequirementsAdd-on to 99497; each additional 30-minute increment reportable at its midpoint (≥ 46 total, then ≥ 76, …).

Documentation required every cycle

Each ACP encounter must show:

1. Voluntary nature of the discussion noted in the record.
2. Total time spent face-to-face on advance care planning (rounded to the minute).
3. A discussion note summarizing what was addressed (code status, surrogate, goals of care, directive type).
4. Directive type on file (POLST / MOLST / Advance Directive) appropriate to the patient's state, with the signed legal form uploaded.
5. Billing practitioner sign-off.

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.