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Are modifiers required when Advanced Care Planning is performed with another service?

Modifier Paired Procedure
95 Telehealth Service
33 Annual Wellness Visit
25 Evaluation & Management (E/M)

When may ACP CPT codes be reported?

  • If ACP is the primary service delivered in a patient visit, an advanced care planning CPT code (1123F, 99497) can be used alone.

  • E/M and ACP can be provided on the same day. Both codes should be reported with modifier-25 added.

  • ACP can be reported during a Medicare AWV. The CPT code should be reported with modifier-33 added to avoid a patient copay.

  • ACP can be reported on the same day as Transitional Care Management (TCM) and Chronic Care Management (CCM) services.

  • If ACP is performed via telehealth the modifier 95 should be added along with the appropriate CPT code.