The Centers for Medicare & Medicaid Services (CMS) requests Medicare Administrative Contractors (MACs) to make payment for Advance Care Planning according to system changes. CMS has made the CPT code 99497 for Advance Care Planning (ACP) separately payable for Medicare OPPS claims when the service meets the criteria for separate payment under OPPS. A Medicare Physician Fee Schedule Database (MPFSDB) update establishes this change. Contractors shall assess deductibles and coinsurance and otherwise evaluate claims with regard to this update.

Full Transmittal: https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R1795OTN.pdf

Subject: Advance Care Planning (ACP) Implementation for Outpatient Prospective Payment System (OPPS) Claims

Number: 1795

Title: Change Request 9862

Release Date: Feb. 10, 2017

Effective Date: Jan. 1, 2017

Implementation Date: July 3, 2017

Special Notes: N/A