Overview
CPT® Code 99497 is used to report advanced care planning (ACP) services provided to an individual patient for the first 30 minutes of face-to-face counseling. ACP involves discussions between a physician or qualified healthcare professional and the patient (and/or family) about goals of care, treatment preferences, and end-of-life planning.
The service may include the creation or review of advance directives, health care proxy forms, or other legal documentation related to patient care preferences. CPT 99497 reflects the time spent counseling and facilitating these decisions; any additional medical evaluation or management is reported separately.
Key Facts About CPT® 99497
- Service type: Advanced care planning / patient counseling
- Provider type: Physicians, nurse practitioners, physician assistants, or other qualified healthcare professionals
- Medical services included: Yes—patient-centered counseling on goals of care, treatment preferences, and advance directives
- Typical duration: First 30 minutes of face-to-face counseling
- Common clinical indications:
- Chronic illness management and end-of-life care planning
- Complex medical decision-making discussions
- Patient or family education on advance directives and legal forms
- Hospital, clinic, or outpatient ACP discussions
When to Use CPT® 99497
CPT 99497 is appropriate when:
- A patient receives structured ACP counseling lasting approximately 30 minutes
- Discussions focus on patient goals, treatment preferences, and advance directives
- Counseling may involve family members or legally authorized representatives
- The service is distinct from routine evaluation or problem-focused E/M visits
Examples:
- Discussing life-sustaining treatment preferences with a patient newly diagnosed with a terminal illness
- Reviewing and updating a patient’s health care proxy and advance directive
- Counseling a patient and family on hospice eligibility and care planning
Documentation Requirements
To properly support CPT 99497 billing, documentation should include:
- Patient identifiers and date of service
- Total time spent counseling (first 30 minutes)
- Topics discussed (advance directives, goals of care, treatment preferences)
- Participant(s) present during the discussion
- Recommendations, decisions, or documentation completed
- Evidence of informed patient consent and understanding
Accurate documentation ensures compliance, proper reimbursement, and continuity of care.
Reimbursement and Coding Considerations
- CPT 99497 is covered by Medicare and many commercial insurers when medically necessary
- A separate code (99498) is used for each additional 30 minutes beyond the initial session
- Must be distinct from E/M or other counseling visits on the same date
- Modifier use may be required if billing alongside other services
- Verify payer-specific rules for ACP coverage and reimbursement
How OptiMantra Supports Advanced Care Planning
OptiMantra’s integrated EMR and practice management system makes ACP documentation, tracking, and billing seamless:
With OptiMantra, providers can:
- Log ACP counseling sessions with automated time tracking
- Use structured ACP templates aligned with 99497 documentation requirements
- Record patient goals, advance directives, and family discussions directly in the chart
- Generate audit-ready, compliant billing codes for first and subsequent 30-minute sessions
- Link ACP documentation with overall care plans for chronic illness or end-of-life management
By centralizing ACP workflows, OptiMantra ensures accurate records, smooth operations, and proper reimbursement for advanced care planning services.
Try OptiMantra for free here!
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