Is CPT 99497 an add on code?
CPT codes 99497 and 99498 are time-based codes (a base code and an add-on code).
Does CPT 99497 require a modifier?
Yes. Advance care planning is a preventive service only when provided in conjunction with an annual wellness visit and reported with modifier 33 attached to the advance care planning code (e.g., 99497-33).
What is the RVU for 99497?
2.25 RVU'sIn the final CY 2022 Physician Fee Schedule, the total facility RVU for 99497 is valued at 2.25 RVU's, while the 99498 code is valued at 2.12 RVU's; rounded, this approximates to $77.86 and $73.37, respectively at a conversion factor of $34.6062.
Can 99214 and 99497 be billed together?
The cardiologist may submit for reimbursement for both 99214 and 99497, 30 minutes of ACP discussion. Completion of documents is not required for reimbursement of ACP codes.
Is 99497 a time based code?
ACP Coding The two CPT codes used to report ACP services are: 99497 First 30 minutes (minimum of 16 minutes) 99498 Add-on for additional 30 minutes.
Can you bill 99497 with E&M?
Code 99497 can be billed on the same day as an E&M visit or [Annual Wellness Visit]. If billed with another E&M, modifier 33 should be included so the patient has no copay or deductible.
What diagnosis code should be billed with 99497?
“Codes 99497 and 99498 are used to report the face-to-face services between a physician or other qualified health care professional and a patient, family member or surrogate in counseling and discussing advance directives, with or without completing relevant legal forms.”
How much does Medicare reimburse per RVU?
On the downside, CMS set the 2022 conversion factor (i.e., the amount it pays per RVU) at $33.59, which is $1.30 less than the 2021 conversion factor. There was also mixed news on telehealth.
What is the dollar value of an RVU 2021?
For each year, work RVUs and conversion factors of that specific year were applied to the formula, $36.04 for 2019 and $32.41 for 2021.
When should modifier 33 be used?
If you provide multiple preventive medical services to the same non-Medicare patient on the same day, append modifier 33 to the codes describing each preventive service rendered on that day. You may also apply modifier 33 when a preventive service must be converted to a therapeutic service.
Can CPT 99497 be billed with G0439?
This year also Medicare made it clear that you can bill the advance care planning codes 99497 and 99498 along with an annual wellness visit (AWV) code G0438 or G0439.