Medicaid

Georgia Medicare Advance Care Planning ACP 2026

The Medicare Advance Care Planning benefit gives every Georgia Medicare beneficiary the right to receive paid time with a physician, nurse practitioner, physician assistant, clinical nurse

Brevy Care Team

· 33 min read

By Brevy Care Team · Last verified May 14, 2026

The Medicare Advance Care Planning benefit gives every Georgia Medicare beneficiary the right to receive paid time with a physician, nurse practitioner, physician assistant, clinical nurse specialist, or certified nurse midwife to engage in voluntary discussion of their preferences for future medical care, completion of advance directive documents, identification of healthcare surrogate decision makers, and education about end-of-life care options including the Medicare hospice benefit. ACP services are billed under CPT 99497 (Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; first 30 minutes, face-to-face with the patient, family member(s), and/or surrogate) and CPT 99498 (each additional 30 minutes). The codes became effective January 1, 2016 under the CY 2016 Medicare Physician Fee Schedule final rule, representing the first dedicated Medicare payment for advance care planning conversations.

The ACP benefit has a uniquely dual structure that distinguishes it from every other Medicare service. ACP can be billed in either of two structurally distinct ways:

Standalone billable ACP — When ACP is furnished as a separately identifiable service not attached to an Annual Wellness Visit, the standard Part B cost-sharing applies (deductible + 20% coinsurance). Standalone ACP can be furnished at any time as clinically appropriate including after a serious diagnosis, during cognitive assessment, prior to surgery, in advanced illness, or at any point when ACP discussion is warranted.
ACP add-on to the Annual Wellness Visit — When ACP is furnished as part of the same encounter as an AWV, with the ACP documented as a separately identifiable service component, the ACP is subject to NO cost-sharing under the ACA Section 4104 preventive services cost-sharing waiver. The AWV-attached ACP delivery pathway makes ACP entirely free to the beneficiary.

This dual structure makes ACP the only Medicare service with both fee-for-service AND preventive-attached delivery pathways. The structural innovation reflects CMS's recognition that ACP discussion is particularly important during the AWV annual prevention-focused encounter while also acknowledging that ACP often arises in clinically driven contexts (post-diagnosis, advanced illness, cognitive impairment) outside the AWV framework.

For Georgia Medicare beneficiaries, the ACP benefit operates within a state framework defined by the Georgia Advance Directive for Health Care Act (OCGA Title 31, Chapter 32), the Georgia POST (Physician Orders for Sustaining Treatment) program, and a substantial palliative care and hospice infrastructure anchored by Emory Healthcare, Wellstar Health System, Piedmont Healthcare, the academic medical centers, and major Georgia hospice organizations operating under the Georgia Hospice and Palliative Care Organization (GHPCO) framework. The Georgia Advance Directive for Health Care statute combines what other states traditionally separate (living will and durable power of attorney for health care) into a single statutory advance directive document, simplifying the documentation pathway for Georgia beneficiaries.

The ACP benefit also operates within the broader federal framework rooted in the Patient Self-Determination Act of 1990 (Public Law 101-508, signed into law as part of OBRA 1990), which requires Medicare-participating hospitals, nursing facilities, hospices, home health agencies, and other providers to inform patients about their right to make decisions about medical care including the right to accept or refuse treatment and the right to formulate advance directives. The PSDA established the foundational federal framework recognizing patient autonomy and advance directives that the CMS ACP payment innovation in 2016 substantially advanced by creating dedicated reimbursement for the practitioner time required for substantive ACP discussion.

This guide explains how the Medicare ACP benefit works statutorily and clinically, what the CPT 99497 and CPT 99498 coding structure each capture, how the standalone billable vs AWV add-on dual structure operates with the zero-cost-sharing implications of AWV-attached delivery, who is eligible to furnish ACP, what the voluntary discussion requirement means in practice, how ACP coordinates with the cognitive assessment service (CPT 99483) which includes its own ACP element but supports separate ACP billing for more extensive discussion, how ACP coordinates with hospice election under Section 1812(a)(4) of the Medicare hospice benefit, what the Georgia Advance Directive for Health Care statute requires, what the Georgia POST program supports, what telehealth ACP delivery looks like for rural Georgia beneficiaries, and why ACP coverage matters for every Georgia Medicare beneficiary regardless of current health status.

Key Takeaways for Georgia Medicare Beneficiaries

CPT 99497 and CPT 99498 are the Medicare Advance Care Planning codes effective January 1, 2016 under the CY 2016 Medicare Physician Fee Schedule. CPT 99497 covers the first 30 minutes (typical, with a 16-minute minimum to bill); CPT 99498 covers each additional 30 minutes when the conversation extends beyond 30 minutes.
Dual structure: standalone billable OR AWV add-on — ACP can be billed as a standalone service (subject to standard Part B cost-sharing) OR as an add-on to the Annual Wellness Visit (subject to zero cost-sharing under ACA Section 4104 preventive services waiver).
Zero cost-sharing when delivered as AWV add-on — When ACP is furnished during the same encounter as an AWV with appropriate documentation, the ACP is entirely free to the beneficiary. This makes the AWV+ACP combination the most cost-effective Medicare ACP delivery pathway.
Standard Part B cost-sharing for standalone ACP — When ACP is furnished outside the AWV (e.g., after a serious diagnosis, during cognitive assessment, prior to surgery, in advanced illness), the standard Part B deductible and 20% coinsurance apply.
Voluntary discussion requirement — ACP is structurally a voluntary discussion. The beneficiary cannot be required to engage in ACP. ACP is appropriate when the beneficiary wants to discuss preferences for future medical care.
Eligible providers — Physicians (MDs and DOs), nurse practitioners, physician assistants, clinical nurse specialists, and certified nurse midwives can bill ACP.
Patient or surrogate participation — ACP can be furnished with the patient, family member(s), surrogate decision maker, or any combination. Patients with diminished decision-making capacity may engage in ACP through their surrogate.
Time-based coding — CPT 99497 requires at least 16 minutes (the midpoint of the first 30 minutes) of face-to-face time. CPT 99498 requires extension beyond 30 minutes with the additional time documented.
Coordination with CPT 99483 Cognitive Assessment — CPT 99483 includes an ACP element. When more extensive ACP discussion warrants separate billing, both CPT 99483 and CPT 99497/99498 can be billed in the same encounter with documentation distinguishing the work.
For Georgia beneficiaries, ACP supports completion of the Georgia Advance Directive for Health Care (OCGA Title 31, Chapter 32), the Georgia POST (Physician Orders for Sustaining Treatment), and coordinated planning for Medicare hospice election when appropriate.

The Federal Framework Underlying the Medicare ACP Benefit

CPT 99497 and CPT 99498 — Effective January 1, 2016 Under CY 2016 MPFS

The Medicare ACP benefit was established effective January 1, 2016 under the CY 2016 Medicare Physician Fee Schedule final rule. The CY 2016 rulemaking represented the culmination of a sustained advocacy effort spanning many years to establish dedicated Medicare payment for advance care planning conversations, recognizing that substantive ACP discussion requires substantial practitioner time that the standard E/M code framework did not adequately reimburse.

The CY 2016 framework established two codes:

CPT 99497 — Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; first 30 minutes, face-to-face with the patient, family member(s), and/or surrogate.
CPT 99498 — Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; each additional 30 minutes (List separately in addition to code for primary procedure).

Both codes are time-based, with CPT 99497 typically requiring at least 16 minutes of face-to-face time (the midpoint of the first 30 minutes) to bill, and CPT 99498 requiring the conversation to extend beyond 30 minutes with documented additional time.

Section 1861(s)(2)(B) — Physician Services Authority

The underlying statutory authority for ACP payment is Section 1861(s)(2)(B) of the Social Security Act, which authorizes Medicare payment for physician services. CMS established ACP-specific codes within the Section 1861(s)(2)(B) framework through the CY 2016 MPFS rulemaking process.

The Affordable Care Act Section 4104 (March 23, 2010) established the cost-sharing waiver for certain Medicare preventive services. Under Section 4104, the Part B deductible and 20% coinsurance do not apply to preventive services receiving an A or B rating from the U.S. Preventive Services Task Force or to specified Medicare-covered preventive services including the Annual Wellness Visit.

When ACP is furnished as part of the same encounter as an AWV, with the ACP appropriately documented as part of the AWV encounter, the ACP service is subject to the same Section 4104 cost-sharing waiver that applies to the AWV. This makes AWV+ACP completely free to the beneficiary.

The structural mechanism: ACP is an optional element under the AWV authority at Section 1861(hhh) of the Social Security Act. When ACP is furnished during the AWV, the entire encounter remains within the AWV preventive service framework and the Section 4104 cost-sharing waiver applies.

When ACP is furnished outside the AWV (a standalone service, or attached to other clinically driven encounters such as cognitive assessment, post-diagnosis discussion, or pre-surgical evaluation), the standard Part B cost-sharing applies because the encounter is not within the AWV preventive service framework.

Section 1861(hhh) — AWV Authority

Section 1861(hhh) of the Social Security Act establishes the Annual Wellness Visit, which includes various required and optional elements. ACP is an optional element that may be furnished as part of the AWV. The AWV optional ACP element is the basis for the AWV+ACP zero-cost-sharing pathway.

Patient Self-Determination Act (PSDA) of 1990

The Patient Self-Determination Act, enacted as part of OBRA 1990 (Public Law 101-508, signed November 5, 1990), established the foundational federal framework requiring Medicare and Medicaid-participating providers to:

Inform patients about their right to make decisions concerning medical care including the right to accept or refuse medical or surgical treatment and the right to formulate advance directives
Document in the medical record whether or not the patient has executed an advance directive
Implement written policies and procedures regarding advance directives
Provide education to staff and the community on issues concerning advance directives

The PSDA regulations are codified at 42 CFR 489.100-489.104 (for Medicare-participating providers) and parallel provisions in Medicaid regulations.

The PSDA established the foundational federal framework recognizing patient autonomy that the CMS ACP payment innovation in 2016 substantially advanced by creating dedicated reimbursement for substantive ACP discussion.

Section 1812(a)(4) — Medicare Hospice Benefit Coordination

Section 1812(a)(4) of the Social Security Act establishes the Medicare hospice benefit, which beneficiaries may elect when they have a terminal diagnosis with a prognosis of six months or less if the disease runs its normal course (as certified by both a hospice physician and the beneficiary's attending physician). ACP discussion frequently includes education about the hospice benefit, eligibility criteria, services covered, and the choice between continued curative-intent treatment versus hospice comfort-focused care.

ACP and hospice election are distinct events but commonly related — substantive ACP discussion can support an informed hospice election when appropriate, and hospice election itself involves substantial advance care planning components (election of the hospice benefit, identification of attending physician, completion of hospice election documentation).

The Standalone vs AWV Add-On Dual Structure

When ACP is Billed as a Standalone Service

Standalone ACP applies in numerous clinical contexts:

Post-diagnosis discussion — After a new serious diagnosis (cancer, advanced heart failure, dementia, advanced COPD, advanced renal disease, neurodegenerative disease), substantive ACP discussion is often appropriate. The diagnosis may substantially change the beneficiary's perspective on future medical care preferences.
Cognitive assessment context — During or after a CPT 99483 cognitive assessment, more extensive ACP discussion than the 99483-included element may be appropriate, billed separately under CPT 99497/99498.
Pre-surgical evaluation — Before major surgery, ACP discussion of surgical risks and patient preferences for post-operative care (including resuscitation preferences, ventilator/feeding tube preferences, etc.) is often appropriate.
Advanced illness encounter — When a beneficiary with serious illness is being seen for ongoing management, scheduled time for substantive ACP discussion is appropriate.
Surrogate-only encounter — When the beneficiary lacks decision-making capacity, ACP discussion may occur entirely with the surrogate decision maker. Standalone ACP billing supports this.
Hospital or SNF discharge planning — When ACP discussion is part of comprehensive discharge planning for a beneficiary with advanced illness, standalone ACP billing applies.

Standalone ACP is subject to:

Part B deductible (annually)
20% coinsurance after deductible
QMB dual-eligible coverage (cost-sharing covered by Georgia Medicaid)
Medigap coverage per plan structure

The Medicare-approved amount for CPT 99497 is approximately $80-85 (varying by geographic locality), so 20% coinsurance is approximately $16-17 for the first 30 minutes.

When ACP is Billed as AWV Add-On

When ACP is furnished during the same encounter as an AWV, the ACP can be billed as an add-on to the AWV with zero cost-sharing to the beneficiary. The key conditions:

Same encounter — The ACP must occur during the same encounter as the AWV, meaning the same date of service and within the same visit
Separately identifiable — The ACP must be a separately identifiable service from the AWV elements. The practitioner cannot bill ACP for elements already required to be performed as part of the AWV (such as a brief discussion of cognitive impairment or general health goals).
Substantive ACP discussion — The ACP must meet the time-based threshold (at least 16 minutes typically) for the practitioner-patient-surrogate ACP discussion. The ACP discussion must focus on advance directive explanation and completion, future care preferences, surrogate identification, and related ACP-specific content.
Modifier 33 — When ACP is billed as AWV add-on for the zero-cost-sharing pathway, modifier 33 (preventive service) is appended to indicate the preventive service nature.

The AWV+ACP combination is the most cost-effective Medicare ACP delivery pathway. For beneficiaries who have not previously completed advance directives or for whom advance directives warrant review and update, scheduling the AWV with explicit time set aside for substantive ACP discussion enables the entire ACP work to be furnished at zero cost-sharing.

Choosing Between Standalone and AWV Add-On

The choice between standalone and AWV add-on depends on clinical context:

AWV add-on is appropriate when the beneficiary is due for AWV and would benefit from substantive ACP discussion, ACP can be planned for the AWV encounter, and the AWV visit can accommodate the additional time required.
Standalone is appropriate when ACP is clinically driven by a specific event (new diagnosis, advanced illness, cognitive impairment) requiring discussion outside the AWV timing, when the AWV has already been performed and the beneficiary has not had substantive ACP discussion, or when ACP discussion requires substantial time beyond what an AWV encounter can accommodate.

Many practices have implemented systematic workflows ensuring ACP discussion is offered during all AWVs, supporting the AWV+ACP zero-cost-sharing pathway as the default while reserving standalone ACP for clinically driven contexts.

The Voluntary Discussion Requirement

ACP is structurally a voluntary discussion. The beneficiary cannot be required to engage in ACP, and the practitioner must respect the beneficiary's choice about whether to discuss ACP topics. Key implementation considerations:

Opt-in framing — Practices should frame ACP as an opportunity for discussion rather than a required step. "Many of our patients find it helpful to discuss preferences for future medical care. Would you like to spend some time on that today?" is appropriate framing.
No coercion — Beneficiaries who decline ACP discussion should have their decision respected without pressure.
Cultural and religious considerations — Some beneficiaries may have cultural or religious perspectives that affect their willingness to discuss ACP topics. Sensitivity to these perspectives is essential.
Capacity considerations — Beneficiaries with diminished decision-making capacity may engage in ACP through their surrogate decision maker.
Re-offer over time — A beneficiary who declines ACP discussion at one encounter may welcome the discussion at a future encounter as circumstances change.

The voluntary discussion requirement is consistent with the broader patient autonomy framework underlying the Patient Self-Determination Act and the foundational principle that advance directives represent the beneficiary's expression of their own values and preferences.

What ACP Discussion Should Cover

Substantive ACP discussion typically addresses some combination of the following topics:

Values and Goals of Care

What gives the beneficiary's life meaning and quality
Specific concerns about future medical care
Values regarding length of life vs. quality of life
Religious or spiritual perspectives affecting medical decisions

Specific Treatment Preferences

Cardiopulmonary resuscitation (CPR) preferences
Mechanical ventilation preferences
Artificial nutrition and hydration preferences
Hospitalization preferences
ICU care preferences
Specific procedure preferences relevant to the beneficiary's conditions

Advance Directive Documents

Explanation of available advance directive forms (Georgia Advance Directive for Health Care under OCGA 31-32)
Living will components
Healthcare power of attorney / surrogate decision maker designation
Completion of new advance directive or review/update of existing advance directive
Filing/distribution of completed advance directive

Surrogate Decision Maker

Identification of healthcare surrogate (often spouse, adult child, or other trusted family member)
Discussion of the surrogate's understanding of the beneficiary's preferences
Conversation between beneficiary and surrogate about preferences (when surrogate is present)

POST/POLST/MOLST

Explanation of Physician Orders for Sustaining Treatment (Georgia POST program)
Eligibility considerations (typically for seriously ill or frail beneficiaries)
Distinction from advance directives (POST is a medical order; advance directive expresses preferences)
POST completion when appropriate

Hospice and Palliative Care Education

Explanation of palliative care vs. hospice
Medicare hospice benefit overview
Hospice eligibility criteria (terminal diagnosis with 6-month prognosis)
Local hospice options
Conversation about timing of hospice consideration

Common Misconceptions

Address common ACP misconceptions (e.g., that completing advance directives means stopping all treatment, that DNR means do not treat, that hospice means giving up)
Provide accurate information supporting informed decision making

Eligible Providers Furnishing ACP

The following provider types can bill CPT 99497 and CPT 99498:

Physicians (MDs and DOs) — Including primary care, specialty physicians, palliative care physicians, hospice physicians
Nurse Practitioners (NPs) — Operating within their scope of practice
Physician Assistants (PAs) — Operating within their scope of practice
Clinical Nurse Specialists (CNSs)
Certified Nurse Midwives (CNMs)

Note that social workers, chaplains, and other team members who often participate in ACP discussions cannot independently bill ACP. The time captured by CPT 99497/99498 must be performed by the eligible billing provider, though other team members may participate in the broader ACP encounter.

The Georgia Advance Directive for Health Care Framework

OCGA Title 31, Chapter 32 — Georgia Advance Directive for Health Care Act

Georgia's advance directive framework is established under the Georgia Advance Directive for Health Care Act, codified at OCGA Title 31, Chapter 32. The Georgia statute creates a single statutory advance directive document that combines what other states traditionally separate:

Living will — Expression of preferences regarding life-sustaining treatment in specified end-of-life scenarios
Durable power of attorney for health care — Designation of a healthcare agent (surrogate decision maker) to make healthcare decisions when the beneficiary lacks decision-making capacity

The combined statutory document simplifies the advance directive completion pathway for Georgia beneficiaries — one document accomplishes both functions, rather than requiring two separate documents as in some states.

Key features of the Georgia Advance Directive for Health Care:

Statutory form — Georgia provides a statutory form that is presumed valid when properly completed. Alternative documents that comply with the statutory framework are also valid.
Healthcare agent designation — The beneficiary designates a healthcare agent who has authority to make healthcare decisions when the beneficiary lacks decision-making capacity. Successor agents can be designated.
Treatment preferences — The beneficiary can express specific treatment preferences regarding life-sustaining treatment in various end-of-life scenarios.
Witness and notary requirements — The advance directive must be signed by the beneficiary in the presence of two witnesses. Notarization is not required but is common practice.
Effective when capacity is lost — The advance directive becomes operational when the beneficiary lacks decision-making capacity, as determined by the attending physician.
Revocation — The beneficiary can revoke the advance directive at any time while retaining decision-making capacity.

Georgia POST (Physician Orders for Sustaining Treatment)

The Georgia POST program provides medical orders for sustaining treatment, a separate document from the advance directive that translates a seriously ill beneficiary's preferences into actionable medical orders. POST is structurally:

Medical order — Unlike an advance directive (which expresses preferences), POST is a medical order signed by a physician (or qualified APRN/PA) that directs medical providers regarding specific treatments
For seriously ill beneficiaries — POST is appropriate for beneficiaries with serious illness or frailty for whom decisions about resuscitation, hospitalization, and other interventions are anticipated
Bright-pink form — Georgia POST is on a distinctive form supporting recognition across care settings
Portable — POST travels with the patient across hospital, nursing facility, hospice, home, and EMS settings
Signed by physician and patient/surrogate — Both the physician and the patient (or surrogate when patient lacks capacity) sign POST

POST complements rather than replaces the advance directive. The advance directive expresses preferences; POST translates preferences into medical orders for the seriously ill patient.

DNR (Do Not Resuscitate) orders — Specific medical orders limiting resuscitation, often integrated into POST in modern practice
Mental health advance directives — Specific advance directive provisions addressing mental health care
Out-of-hospital DNR orders — Specific orders directing EMS regarding resuscitation outside hospital settings

The Coordination Between ACP and Other Medicare Services

ACP and Annual Wellness Visit (AWV)

The AWV+ACP combination is the principal pathway for zero-cost-sharing ACP delivery. Many practices have implemented systematic workflows ensuring ACP is offered during AWVs, with substantive ACP discussion delivered as the AWV add-on.

When ACP discussion warrants more time than the AWV encounter can accommodate, the ACP can be deferred to a follow-up visit billed as standalone ACP, OR more time can be allocated to the AWV encounter to accommodate the ACP. The choice depends on practice scheduling and beneficiary preferences.

ACP and Cognitive Assessment (CPT 99483)

CPT 99483 cognitive assessment includes an ACP element as element 9 of the 10 required structural elements. When the cognitive assessment ACP element is satisfied by relatively brief ACP discussion, no separate ACP billing is appropriate.

When more extensive ACP discussion warrants separate billing, CPT 99497 (and CPT 99498 when applicable) can be billed in addition to CPT 99483 with documentation distinguishing:

The CPT 99483 ACP element work (typically more limited discussion)
The CPT 99497/99498 additional ACP work (typically substantive advance directive completion or surrogate discussion)

This is particularly relevant for dementia patients during cognitive assessment because:

The dementia diagnosis context makes substantive ACP discussion particularly important
Decision-making capacity may decline rapidly making timing critical
Family caregiver involvement during cognitive assessment supports surrogate identification
Combined CPT 99483 + CPT 99497/99498 captures both the comprehensive cognitive assessment and substantive ACP

ACP and Chronic Care Management (CCM)

ACP discussion can occur within ongoing CCM coordination. When CCM clinical staff have ACP discussions, those activities count toward CCM time. When the eligible practitioner conducts substantive face-to-face ACP discussion, separate ACP billing may be appropriate.

ACP and Transitional Care Management (TCM)

ACP discussion may be particularly important during the post-discharge transition for beneficiaries with serious illness. ACP can be billed in conjunction with TCM when substantive ACP discussion occurs during the face-to-face visit component of TCM.

ACP and Hospice Election

ACP frequently includes hospice education for beneficiaries with serious illness. When ACP discussion leads to hospice election, the ACP captures the discussion work while hospice election itself is a separate administrative process under Section 1812(a)(4) of the Medicare hospice benefit.

ACP can be billed before, during, or after hospice election. When ACP is furnished by the attending physician (who continues to participate in care after hospice election), CPT 99497/99498 captures the work. When ACP is furnished by hospice physicians, the work may be captured under hospice payment rather than CPT 99497/99498.

ACP and Palliative Care Consultation

Palliative care consultation (often by palliative care physician specialists) is a distinct service from ACP, though ACP discussion is a common component of palliative care encounters. Palliative care consultation is billed under E/M codes; the ACP component of the encounter can be billed separately under CPT 99497/99498 when substantive ACP discussion meets the time threshold.

Telehealth ACP Delivery

ACP can be delivered via synchronous audio-video telehealth under current Medicare flexibilities. Key telehealth ACP considerations:

Telehealth eligibility — CPT 99497 and CPT 99498 are eligible for telehealth delivery
Patient-family-surrogate participation — Telehealth supports participation of patient, family members, and surrogate decision maker from different physical locations
Document completion — Advance directive documents typically require in-person witnessing for legal validity. Telehealth ACP discussion can support the conversation while the actual document signing may require separate logistics for witnessing.
Geographic flexibility — Standard Medicare telehealth flexibilities apply
Audio-only considerations — Audio-only ACP is permitted under various flexibilities

Telehealth ACP is particularly important for rural Georgia where access to palliative care specialists is limited. Major Georgia health systems including Emory, Wellstar, and Piedmont operate telehealth palliative care programs supporting rural patient access to substantive ACP discussion.

Major Georgia Health Systems and Palliative Care Programs Delivering ACP

Emory Healthcare

Emory operates comprehensive palliative care programs across the Emory University Hospital, Emory University Hospital Midtown, Emory Saint Joseph's Hospital, Emory Johns Creek Hospital, Emory Decatur Hospital, and Emory Hillandale Hospital. Emory Palliative Care provides hospital-based and outpatient palliative care including substantive ACP support. Emory primary care delivers AWV+ACP and standalone ACP across its primary care network.

Wellstar Health System

Wellstar operates palliative care programs at Wellstar Kennestone Hospital and across its hospital network. Wellstar Hospice provides hospice services across multiple counties. Wellstar primary care delivers ACP across its primary care network.

Piedmont Healthcare

Piedmont operates palliative care services across its hospital network including Piedmont Atlanta Hospital, Piedmont Athens Regional, and other facilities. Piedmont Hospice provides hospice services. Piedmont primary care delivers ACP.

Northside Hospital

Northside operates palliative care services at Northside Hospital Atlanta and other facilities.

Augusta University Health

Augusta University Health operates palliative care services including support for the academic medical center population in east Georgia.

Atrium Health Navicent

Atrium Health Navicent operates palliative care services for central Georgia including hospital-based and outpatient programs.

Memorial Health (Savannah)

Memorial Health operates palliative care services for coastal Georgia.

Phoebe Putney Health System

Phoebe Putney operates palliative care services for southwest Georgia. Phoebe Putney Hospice provides hospice services.

Northeast Georgia Health System

Northeast Georgia operates palliative care services for northeast Georgia.

Georgia Hospice Organizations

Major Georgia hospice organizations include Hospice Atlanta (CSC Hospice), Heartland Hospice, Compassus Hospice, Amedisys Hospice, Crossroads Hospice, Visiting Nurse Health System Hospice, and many regional and community-based hospices. The Georgia Hospice and Palliative Care Organization (GHPCO) is the state association representing hospice and palliative care providers.

Atlanta VA Health Care System Hospice and Palliative Care

The Atlanta VA Health Care System operates palliative care and hospice services for veterans. While VA palliative care is delivered under VA coverage rather than CPT 99497/99498 billing, the VA framework substantially extends ACP access for veteran Medicare beneficiaries.

Rural Georgia Palliative Care Access Considerations

Rural Georgia faces substantial palliative care access constraints:

Specialty palliative care workforce shortage — Palliative care physician and APRN workforce is concentrated in metropolitan areas
Geographic distance to palliative care programs — Many rural beneficiaries are 1-2+ hours from comprehensive palliative care services
Limited specialty workforce in rural hospices — Some rural hospices have limited physician staffing requiring shared physician resources

The Medicare telehealth framework supports rural palliative care access through:

Telehealth palliative care consultation — Telehealth consultation by metropolitan palliative care specialists supports rural patients
Primary care-delivered ACP — Rural primary care physicians, NPs, and PAs can deliver ACP for their patients without requiring specialty palliative care involvement
Hospice physician oversight — Hospice physicians provide medical oversight even when on-site visits are limited

The Georgia Hospice and Palliative Care Organization supports rural hospice and palliative care development through education, advocacy, and coordination across the state.

Six Worked Examples: How ACP Plays Out for Real Georgia Beneficiaries

Example 1: Fulton County 70-Year-Old ACP Add-On to AWV

A 70-year-old woman in Fulton County is enrolled in Emory primary care and presents for her Annual Wellness Visit. During the visit, she expresses interest in completing her advance directive. Her Emory primary care physician completes the required AWV elements and then engages in a 25-minute substantive ACP discussion covering her values, treatment preferences, and completion of the Georgia Advance Directive for Health Care designating her daughter as healthcare agent. The encounter is billed as AWV (G0438 subsequent AWV) plus CPT 99497 with modifier 33. The beneficiary has $0 cost-sharing for the entire encounter under the ACA Section 4104 preventive services waiver. The completed advance directive is uploaded to the medical record and the patient receives a copy with instructions on distribution to her daughter and her medical records.

Example 2: DeKalb County 78-Year-Old Standalone ACP After Serious Diagnosis

A 78-year-old man in DeKalb County is newly diagnosed with metastatic non-small cell lung cancer at Piedmont. His oncologist refers him for substantive ACP discussion with his Piedmont primary care physician. The PCP schedules a 35-minute follow-up visit specifically for ACP. The discussion covers his prognosis understanding, treatment preferences regarding chemotherapy and end-of-life care, hospice education, completion of the Georgia Advance Directive for Health Care designating his wife as healthcare agent, and discussion of the Georgia POST program (with POST completion deferred pending further clinical evolution). The encounter is billed as CPT 99497 standalone with Part B cost-sharing applying (deductible already met, 20% coinsurance of approximately $17).

Example 3: Cobb County 82-Year-Old ACP with Surrogate Following Cognitive Assessment

An 82-year-old woman in Cobb County is evaluated at Wellstar Memory Health Network. The CPT 99483 cognitive assessment confirms moderate Alzheimer's disease. The 10 elements of CPT 99483 are completed including a brief ACP element. The neurologist recognizes that more extensive ACP discussion is warranted given the dementia diagnosis and engages in additional 35-minute substantive ACP discussion with the patient and her daughter (primary caregiver and prospective surrogate). The encounter is billed as CPT 99483 plus CPT 99497 and CPT 99498 (additional 30 minutes for the second 30 minutes of ACP work beyond the first 30 minutes). Documentation distinguishes the CPT 99483 work from the substantive separately-identifiable ACP work. Cost-sharing: Part B deductible plus 20% coinsurance applies to all codes.

Example 4: Worth County 75-Year-Old Rural Telehealth ACP

A 75-year-old man in Worth County, rural southwest Georgia, has advanced heart failure (NYHA Class III) managed by Phoebe Putney cardiology. His Phoebe Putney primary care physician schedules a telehealth ACP visit given the patient's advanced illness and the family's expressed interest in advance directive completion. The 30-minute telehealth ACP visit includes the patient (joining from his home), his wife, and his adult son (joining from the son's home in Atlanta). The discussion covers treatment preferences, completion of the Georgia Advance Directive for Health Care, surrogate identification (wife with son as successor), and hospice education. The advance directive document signing is deferred to an in-person follow-up visit for witness signatures. The telehealth encounter is billed as CPT 99497 standalone with Part B cost-sharing.

Example 5: Bibb County 85-Year-Old ACP Coordinating with Hospice Election

An 85-year-old man in Bibb County has advanced metastatic prostate cancer with disease progression despite multiple lines of therapy. His Atrium Health Navicent oncologist and primary care physician have discussed transitioning to hospice. A dedicated ACP visit with the PCP is scheduled to address his preferences before hospice election. The 40-minute visit includes substantive discussion of his goals of care, treatment preferences, hospice benefit education (services covered, attending physician role, election process), completion of the Georgia Advance Directive for Health Care, and Georgia POST completion specifying DNR and limited hospitalization preferences. The encounter is billed as CPT 99497 plus CPT 99498 (the conversation extending beyond 30 minutes warranting the add-on code). Within two weeks, the patient elects the Medicare hospice benefit with the attending physician continuing as the primary medical contact.

Example 6: Hall County 77-Year-Old ACP + AWV Split Decision

A 77-year-old woman in Hall County presents for her Annual Wellness Visit at Northeast Georgia primary care. She mentions wanting to discuss advance directives. Her PCP completes the required AWV elements within the scheduled 30-minute appointment but recognizes that substantive ACP discussion will require more time than remains. She schedules a follow-up visit specifically for ACP. The AWV is billed without ACP add-on. Two weeks later, the patient returns for a 35-minute dedicated ACP visit covering her values, treatment preferences, advance directive completion, and surrogate designation. The standalone ACP is billed as CPT 99497 with Part B cost-sharing applying.

Fourteen Best Practices for ACP Implementation

Offer ACP routinely during AWVs — Make AWV+ACP the default workflow, capturing the zero-cost-sharing pathway whenever beneficiaries are willing to engage.
Allow sufficient time — Substantive ACP discussion typically requires 20-40 minutes. Schedule appointment time accordingly and avoid rushing the discussion into inadequate time.
Document discussion content — Document the topics covered, beneficiary preferences expressed, surrogate identification, and any documents completed. The documentation supports the billing and creates a record for future care.
Complete advance directive documents — When the beneficiary is ready, complete the Georgia Advance Directive for Health Care during the visit. Have the form available with appropriate witness arrangements.
Educate about Georgia POST — For seriously ill beneficiaries, discuss Georgia POST and complete when appropriate. POST translates preferences into actionable medical orders.
Identify surrogate decision maker — Encourage beneficiaries to identify a healthcare surrogate and discuss preferences with that person. The surrogate's understanding of preferences is essential for surrogate decision making to reflect the beneficiary's values.
Distribute completed advance directive — After completion, ensure copies are distributed to the surrogate, primary care record, hospitals where the beneficiary receives care, and family members as appropriate.
Address common misconceptions — Be prepared to address misconceptions about advance directives ("they mean stopping treatment"), DNR ("means do not treat"), and hospice ("means giving up").
Respect voluntariness — ACP is voluntary. Respect beneficiaries who decline discussion and re-offer at future visits as circumstances evolve.
Use Georgia-specific forms — Use the Georgia Advance Directive for Health Care (OCGA 31-32) as the primary advance directive form for Georgia beneficiaries. Alternative documents complying with the Georgia statutory framework are also valid.
Coordinate with cognitive assessment — When ACP discussion exceeds the CPT 99483 ACP element scope, bill separately under CPT 99497/99498 with documentation distinguishing the work.
Apply Modifier 33 for AWV add-on — When ACP is delivered as AWV add-on for zero cost-sharing, apply modifier 33 to indicate the preventive service nature.
Leverage telehealth for rural patients — Use telehealth ACP for rural patients whose access to in-person palliative care is constrained. Document the telehealth modality.
Re-visit ACP periodically — Advance directives and ACP discussions should be revisited periodically as health status changes, family circumstances change, and beneficiary preferences may evolve.

Fourteen Common ACP Issues and How to Avoid Them

Inadequate time documentation — ACP requires time-based documentation. CPT 99497 typically requires at least 16 minutes face-to-face time. Document the specific time spent on the ACP discussion.
Failure to apply Modifier 33 — When ACP is delivered as AWV add-on, missing modifier 33 may result in cost-sharing being applied to the beneficiary. Always apply modifier 33 for AWV-attached ACP.
Billing AWV+ACP without substantive ACP work — The ACP add-on requires substantive ACP discussion separately identifiable from AWV elements. Billing ACP add-on for routine AWV elements is inappropriate.
Failing to inform beneficiaries about standalone ACP cost-sharing — Beneficiaries should understand the cost-sharing structure when ACP is billed standalone. Inform them before service delivery.
Treating ACP as one-time event — ACP is a process not an event. Plan for periodic ACP revisits as health status and circumstances change.
Using out-of-state advance directive forms — Use the Georgia Advance Directive for Health Care (OCGA 31-32) for Georgia beneficiaries. Out-of-state forms may not be valid under Georgia law.
Confusing advance directive and POST — These are different documents with different purposes. Advance directive expresses preferences (broad). POST is a medical order for the seriously ill (specific). Both have appropriate uses.
Failing to identify a healthcare agent — The advance directive's most important practical feature is healthcare agent designation. Without an identified agent, family conflicts about surrogate decision making may arise.
Not engaging the surrogate — A surrogate who doesn't understand the beneficiary's preferences cannot effectively make decisions reflecting those preferences. Encourage beneficiary-surrogate conversation.
Coercing reluctant beneficiaries — ACP must be voluntary. Beneficiaries who decline should have their decision respected without pressure.
Forgetting cultural considerations — Some cultures and religions have different perspectives on end-of-life discussion. Approach with sensitivity to the beneficiary's cultural context.
Inadequate documentation distinguishing CPT 99483 ACP from separate ACP — When billing both CPT 99483 (which includes ACP element) and CPT 99497/99498 (more extensive ACP), documentation must distinguish the work captured by each code.
Not distributing completed advance directive — A completed advance directive accomplishes nothing if family members and providers don't have it. Ensure distribution after completion.
Failure to address common misconceptions — Misconceptions about advance directives, DNR, and hospice often prevent meaningful ACP discussion. Address them proactively.

Frequently Asked Questions

What is Medicare Advance Care Planning (ACP)?

Medicare ACP is voluntary discussion between a practitioner and a beneficiary (or surrogate decision maker) about preferences for future medical care, including explanation and completion of advance directive documents. ACP is billed under CPT 99497 (first 30 minutes) and CPT 99498 (each additional 30 minutes). The codes became effective January 1, 2016 under the CY 2016 Medicare Physician Fee Schedule.

When did Medicare establish ACP coverage?

The Medicare ACP benefit became effective January 1, 2016 under the CY 2016 Medicare Physician Fee Schedule final rule. This represented the first dedicated Medicare payment for advance care planning discussions.

What is the difference between standalone ACP and ACP add-on to AWV?

Standalone ACP is billed independently as a separate encounter or as part of a clinically driven encounter (post-diagnosis, advanced illness, etc.) and is subject to standard Part B cost-sharing. ACP add-on to AWV is billed as part of the same encounter as an Annual Wellness Visit with modifier 33 and is subject to zero cost-sharing under the ACA Section 4104 preventive services waiver.

Is ACP free for Medicare beneficiaries?

ACP is free (zero cost-sharing) when delivered as an add-on to the Annual Wellness Visit. Standalone ACP is subject to standard Part B cost-sharing (deductible + 20% coinsurance).

What is the minimum time to bill CPT 99497?

CPT 99497 typically requires at least 16 minutes of face-to-face time (the midpoint of the first 30 minutes). The full 30 minutes is the typical duration but the threshold of 16 minutes generally supports billing.

When is CPT 99498 billed?

CPT 99498 is billed when the ACP discussion extends beyond 30 minutes, capturing each additional 30 minutes. CPT 99498 is listed in addition to CPT 99497 — it cannot be billed alone.

Who can bill ACP?

Physicians (MDs and DOs), nurse practitioners, physician assistants, clinical nurse specialists, and certified nurse midwives can bill CPT 99497 and CPT 99498. Social workers, chaplains, and other team members who may participate in ACP discussions cannot independently bill ACP.

Is ACP voluntary?

Yes. ACP is structurally a voluntary discussion. The beneficiary cannot be required to engage in ACP. Beneficiaries who decline discussion should have their decision respected.

Can ACP be delivered via telehealth?

Yes. CPT 99497 and CPT 99498 are eligible for synchronous audio-video telehealth delivery under current Medicare flexibilities. Telehealth ACP is particularly important for rural beneficiaries.

What is the Georgia Advance Directive for Health Care?

The Georgia Advance Directive for Health Care is the state's combined advance directive document established under OCGA Title 31, Chapter 32. It combines living will (treatment preferences) and durable power of attorney for health care (healthcare agent designation) into a single statutory form. Georgia provides a statutory form that is presumed valid when properly completed.

What is Georgia POST?

Georgia POST (Physician Orders for Sustaining Treatment) is a medical order signed by a physician (or qualified APRN/PA) that translates a seriously ill beneficiary's preferences into actionable medical orders. Unlike an advance directive (which expresses preferences), POST is a medical order. POST is on a distinctive bright-pink form and is portable across care settings.

Can ACP be billed in the same encounter as cognitive assessment (CPT 99483)?

Yes. CPT 99483 includes an ACP element but more extensive ACP discussion can be billed separately under CPT 99497/99498. When both are billed, documentation must distinguish the CPT 99483 ACP element work from the separately-identifiable substantive ACP work.

Does ACP have to result in a completed advance directive?

No. ACP is the discussion. Completion of an advance directive document is optional and depends on whether the beneficiary is ready to commit preferences to writing. ACP can be billed for substantive discussion even if no document is completed during the encounter.

Can ACP be furnished with a surrogate when the patient lacks capacity?

Yes. ACP discussion can occur with the patient, family members, surrogate decision maker, or any combination. When the patient lacks decision-making capacity, ACP discussion may occur entirely with the surrogate.

What is Modifier 33?

Modifier 33 indicates that the service is a preventive service eligible for the ACA Section 4104 cost-sharing waiver. When ACP is delivered as AWV add-on for zero cost-sharing, modifier 33 is applied to the CPT 99497 (and CPT 99498 if applicable) billing.

Can ACP coexist with hospice election?

Yes. ACP and hospice election are distinct events. ACP discussion frequently leads to or supports hospice election, but the two are billed separately. ACP can be billed before, during, or after hospice election.

How often can ACP be billed?

There is no specific frequency limit on ACP. Substantive ACP discussion can occur multiple times per year when clinically appropriate (e.g., new diagnosis, change in health status, revisiting preferences). Each billing requires substantive ACP work meeting the time threshold.

Does Medicare Advantage cover ACP?

Yes. Medicare Advantage plans cover ACP services consistent with traditional Medicare coverage, though cost-sharing structure may differ from traditional Medicare. The AWV+ACP zero-cost-sharing pathway also applies in Medicare Advantage.

What is the Patient Self-Determination Act (PSDA)?

The PSDA (Public Law 101-508, signed November 5, 1990) established the federal framework requiring Medicare and Medicaid-participating providers to inform patients about their right to make decisions about medical care including the right to formulate advance directives. The PSDA is the foundational federal advance directive framework.

What is the relationship between ACP and hospice?

ACP discussion frequently includes hospice education for beneficiaries with serious illness. When ACP leads to hospice election, the ACP captures the discussion work while hospice election is a separate administrative process under Section 1812(a)(4). The Medicare hospice benefit provides comprehensive comfort-focused care for beneficiaries with a terminal diagnosis and prognosis of 6 months or less.

Can advance directive documents be signed during telehealth ACP?

Telehealth ACP discussion supports the conversation but the actual advance directive document signing typically requires in-person witnessing for legal validity under Georgia law. Many practices arrange for in-person follow-up for document execution or use witness arrangements compatible with telehealth-supported document completion.

What major Georgia health systems deliver ACP?

Major Georgia ACP-delivering health systems include Emory Healthcare, Wellstar Health System, Piedmont Healthcare, Northside Hospital, Augusta University Health, Atrium Health Navicent, Memorial Health, Phoebe Putney Health System, Northeast Georgia Health System, and the Atlanta VA Health Care System. Each system has palliative care programs supporting ACP delivery in addition to primary care-based ACP.

Where can Georgia beneficiaries get advance directive forms?

The Georgia Advance Directive for Health Care statutory form is available from multiple sources including the Georgia Department of Public Health, Georgia hospitals and health systems, Georgia Hospice and Palliative Care Organization, Atlanta Legal Aid Society and Georgia Legal Services Program (for those needing legal assistance), and online resources. The Five Wishes form and other advance directive resources are also valid in Georgia when compliant with the OCGA 31-32 framework.

What is the role of palliative care in ACP?

Palliative care specialists frequently engage in substantive ACP discussion as part of comprehensive palliative care consultation. Palliative care consultation is billed under E/M codes; substantive ACP discussion components can be billed separately under CPT 99497/99498. Palliative care is appropriate at any stage of serious illness, not only end-of-life.

Does ACP discussion have to occur in person?

No. Telehealth ACP via synchronous audio-video is eligible under current Medicare flexibilities. Audio-only ACP is also permitted under various flexibilities. However, advance directive document signing typically requires in-person witnessing.

CTA: Contacts for Georgia Medicare ACP Resources

Federal Medicare resources

Medicare — 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048
Palmetto GBA (Georgia Medicare Administrative Contractor) — 1-866-238-9650
Eldercare Locator — 1-800-677-1116

Advance care planning resources

The Conversation Project — Free starter kits supporting ACP discussion
Five Wishes — Comprehensive advance directive program (compatible with Georgia law)
Caring Connections — National Hospice and Palliative Care Organization consumer resource
National Hospice and Palliative Care Organization (NHPCO)

Georgia state resources

Georgia Department of Public Health — 404-657-2700 (advance directive forms)
Georgia Hospice and Palliative Care Organization (GHPCO)
Georgia DCH Medicaid Member Services — 1-866-211-0950
GeorgiaCares SHIP — 1-866-552-4464

Advocacy and consumer assistance

Medicare Rights Center — 1-800-333-4114
Atlanta Legal Aid Society — 404-377-0701 (elder law, advance directive assistance)
Georgia Legal Services Program — 1-800-498-9469
211 Georgia — Dial 211
Acentra Health (Georgia QIO) — 1-844-455-8708

Social Security Administration — 1-800-772-1213

Conclusion: Why ACP Coverage Matters for Every Georgia Medicare Beneficiary

The Medicare Advance Care Planning benefit represents one of the most important Medicare policy advances of the past decade. The CPT 99497/99498 framework established January 1, 2016 created dedicated reimbursement for substantive ACP discussion that the standard E/M code framework did not adequately support, enabling primary care physicians, nurse practitioners, palliative care specialists, and other eligible providers to engage in the substantive ACP conversations that meaningfully inform future medical care decisions.

The dual structure of ACP — standalone billable OR AWV add-on with zero cost-sharing — makes ACP the only Medicare service with both fee-for-service and preventive-attached delivery pathways. The AWV+ACP zero-cost-sharing combination represents the most accessible and cost-effective ACP delivery pathway, enabling every Georgia Medicare beneficiary to engage in substantive ACP discussion entirely free during their annual wellness encounter. The standalone ACP pathway supports the clinically driven contexts where ACP arises outside the AWV — after a serious diagnosis, during cognitive assessment, in advanced illness, prior to surgery, or in hospice transition planning.

For Georgia Medicare beneficiaries, the ACP benefit operates within a state framework defined by the Georgia Advance Directive for Health Care statute (OCGA Title 31, Chapter 32) combining living will and durable power of attorney for health care into a single statutory document, the Georgia POST program translating preferences into actionable medical orders for the seriously ill, and a substantial palliative care and hospice infrastructure across Emory Healthcare, Wellstar Health System, Piedmont Healthcare, Northside Hospital, Augusta University Health, Atrium Health Navicent, Memorial Health, Phoebe Putney Health System, Northeast Georgia Health System, the Atlanta VA Health Care System, and major Georgia hospice organizations. The Georgia Hospice and Palliative Care Organization supports the statewide palliative care community through education, advocacy, and coordination.

The federal framework supporting ACP rests on the foundational Patient Self-Determination Act of 1990, which recognized patient autonomy and the right to formulate advance directives as fundamental aspects of healthcare decision making. The CMS payment innovation in 2016 substantially advanced the PSDA framework by creating dedicated reimbursement for the practitioner time required for substantive ACP discussion.

Every Georgia Medicare beneficiary deserves the opportunity to discuss preferences for future medical care, identify a healthcare surrogate decision maker, complete advance directive documents, and prepare for the uncertainties of future health changes. The ACP benefit makes this possible at zero cost (via AWV+ACP) or modest cost (via standalone ACP) for every Georgia beneficiary. The work of expanding ACP utilization across Georgia primary care — particularly through systematic AWV+ACP integration making the zero-cost-sharing pathway the default — represents one of the most consequential opportunities in Georgia Medicare policy for honoring patient preferences, reducing family decision-making burden, and improving end-of-life care alignment with the values of the older Georgians depending on the Medicare program.