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TRICARE Policy Manual 6010.60-M, April 1, 2015
Chapter 1
Section 14.3
Advance Care Planning (ACP) Services
Issue Date:  July 19, 2016
Authority:  32 CFR 199.4(c)(1)(ii)
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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