Advance Care Planning in the AWV: An Operational Reference
Voluntariness, distinct time, documentation, modifier 33, telehealth, and cost-sharing controls for 99497 and 99498.
Voluntary and optional boundary
Advance Care Planning (ACP) is an optional and strictly voluntary discussion. It is not a required element of the Annual Wellness Visit (AWV). A patient may decline ACP without affecting an otherwise supported and billable AWV.
How to bill 99497 and 99498
Ensure you meet the current minimum-time conventions before billing for ACP.
| Code | Reference | Operational control |
|---|---|---|
| 99497 | First 30 minutes | Verify the current CPT code-year and payer minimum-time threshold before billing. |
| 99498 | Each additional 30 minutes | Use only after both the base time and the additional-time thresholds are fully supported. |
How to capture time and documentation
A complete ACP record must clearly document the voluntary nature of the discussion and the time spent.
- Participants: List the patient, practitioner, family/surrogate, interpreter, and anyone else present.
- Consent: Document the voluntary explanation and the patient's accepted, declined, or deferred response.
- Topics: Record the specific goals, values, treatment preferences, designated decision-makers, directives, and questions discussed.
- Time boundaries: Log distinct start/stop times or the total face-to-face ACP time. Exclude interruptions and non-ACP work.
- Outcomes: Note any documents reviewed/completed, decisions made, follow-up owner/date, and practitioner authentication.
How to manage modifier 33 and cost-sharing
CMS guidance may permit the waiver of deductibles and coinsurance for qualifying ACP furnished during a covered AWV, commonly indicated by appending modifier 33.
How to handle telehealth and time overlaps
Strictly separate ACP time from other clinical activities to avoid double-counting.
- Telehealth requirements: Verify the current CMS telehealth-list status, payer policy, practitioner licensure, patient location, consent, privacy, modality, place of service, and applicable modifier.
- Time separation: Keep ACP time completely distinct from E/M, RPM, RTM, CCM, and other time-based services. Never double-count time.
- Exclude routine AWV time: Do not count routine AWV preparation or prevention-plan discussions as ACP time.
How to handle declines and nonbillable discussions
| Outcome | Required action |
|---|---|
| Declined / Deferred | Record the offer, its voluntary nature, the patient's response, and any requested follow-up. Continue the AWV normally. |
| Below reporting threshold | Retain the documentation clinically. Do not bill unless current time requirements are met. |
| Rules unmet | Do not report unsupported ACP. |
Team role responsibilities
| Role | Responsibility |
|---|---|
| Support staff | Offer approved information, prepare relevant documents, and route questions to the clinician. |
| Billing practitioner | Conduct the service as allowed, exercise clinical judgment, document specific content and distinct time, and authenticate the record. |
| Biller | Verify codes, units, modifier 33 rationale, telehealth fields, and specific payer instructions. |
Recommended operational implementation
Note: A status model and a time-capture control can help distinguish between offered, declined, documentation-pending, billable, and nonbillable outcomes. These are implementation recommendations—not CMS mandates or claims of a shipped FairPath module or timer.
Sources (public)
FairPath is designed to handle this complexity for you.
While most platforms simply record what happened, FairPath actively runs the program. It continuously monitors every patient, staff action, and billing rule across CCM, RPM, RTM, and APCM, intervening immediately when a requirement is missed.
This allows you to scale your own program without losing quality, breaking trust with physicians, or losing control of your revenue. We provide the precision of an automated medical director without the chaos.