ACP Medical Billing: A Practical Guide to Getting Paid for Advance Care Planning

Advance Care Planning matters. Patients get clarity about future care, and clinicians document wishes that actually guide decisions later on. The billing part is where many teams stumble. Notes don’t match time, add-on minutes get missed, or payers treat the visit as routine counseling. That’s where disciplined acp medical billing helps.

If your team is building stronger guardrails around billing accuracy, start with your foundations in Healthcare Billing Compliance and Medical Billing Compliance.

What ACP billing really covers

ACP is a structured, voluntary conversation about goals of care. It often includes advance directives, medical power of attorney, and preferences for serious-illness scenarios. The goal isn’t just reimbursement. It’s documentation that stands up to payer review and protects patient intent.

Codes and time (keep it simple)

Most practices use two codes:
• 99497 for the first 30 minutes
• 99498 for each additional 30 minutes

Write down the actual duration. If you go past the first half hour, capture it and use the add-on. If you stop early, don’t round up. Good timekeeping is half of acp billing.

What payers expect in the note

Think of the note as a quick checklist you could defend in an audit:
• Who was present (patient, caregiver) and that the talk was voluntary
• Topics covered (advance directives, goals of care, surrogate, forms started or updated)
• Start/stop times and total minutes
• Setting (clinic, inpatient, telehealth) and the credentialed clinician
• Any decisions made or next steps

Common ACP billing mistakes (and quick fixes)

• Missing time → Add start/stop and total minutes every time.
• Forgetting 99498 → If you legitimately crossed 30 minutes, bill it.
• Bundling confusion → Some same-day services are allowed; let documentation do the talking.
• Vague notes → Name what you discussed and what changed.
• Wrong setting or credentials → Make sure the rendering provider and place of service are clear.

Medicare specifics in two lines

Medicare pays for ACP in inpatient, outpatient, and (where allowed) telehealth settings when properly documented. Use 99497 for the first half hour, 99498 for additional time, and keep the note tight and factual.

A simple ACP workflow you can stick to

1) Identify the patient and explain the purpose.
2) Document a real conversation, not a template dump.
3) Record start/stop time before you move on to the next patient.
4) Code 99497, add 99498 when time qualifies.
5) Spot-check a few charts weekly to catch drift early.

Frequently Asked Questions (FAQ)

Which CPT codes are used for ACP?

99497 for the first 30 minutes, 99498 for each additional 30 minutes.

Can ACP be billed on the same day as other services?

Yes, when your documentation supports it and the time for ACP is clearly separate and recorded.

What must be in the note for clean ACP billing?

Who attended, that it was voluntary, subjects discussed, forms addressed, start/stop times with total minutes, setting, and clinician credentials.

Do payers require consent forms for ACP?

Formal signed consent isn’t required for billing, but the discussion must be voluntary and documented as such.

Why do ACP claims get denied?

Missing time, no add-on code when time qualifies, vague notes, or confusion with preventive counseling.

Is telehealth ACP covered?

Often, yes, but follow current payer rules. Make sure the note states it was telehealth and includes all usual elements.

What’s the fastest way to improve ACP reimbursements?

Tighten documentation, capture exact time, use 99498 when due, and run a light weekly audit to prevent repeat errors.