ALERT!!
MONTHLY MAINTENANCE: The DHA network is scheduled for monthly maintenance on Saturday, May 21st at 6:00am (EST) until Sunday, May 22nd at 11:59pm (EST). The TRICARE Manuals web site may be available intermittently during this period but its usage is not recommended.
Administration
Chapter 1
Section 14.3
Advance Care Planning (ACP)
Services
Issue Date: July 19, 2016
Copyright: CPT
only © 2006 American Medical Association (or such other date of
publication of CPT). All Rights Reserved.
Revision: C-1, March 10, 2017
1.0 CPT
Codes
99497, 99498
2.0 Description
ACP services are face-to-face consultation
services between a TRICARE-authorized provider and a patient, family
member, or surrogate for the purpose of discussing end-of-life care
planning. These services may also include the completion of advance
directive documents such as:
• Healthcare Proxy;
• Durable Power of
Attorney for Health Care;
• Living Will and
Medical Orders for Life-Sustaining Treatment.
3.0 Policy
3.1 ACP services
are covered when provided in connection with medically and psychologically necessary
treatment of an injury or illness in an outpatient, inpatient, or
Skilled Nursing Facility (SNF) setting.
3.2 Cost-sharing and copays apply.
4.0 Exclusion
ACP services are not covered when provided
in connection with a preventive services office visit (e.g., CPT codes
99381-99387 and 99391-99397).
5.0 Effective
Date
January 1, 2016.
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