Advance Care Planning for FQHCs For providers billing under the Medicare Prospective Payment System (PPS) for Federally Qualified Health Centers (FQHCs), Advance Care Planning is a stand-alone billable visit. If furnished on the same day as another billable visit, only one visit will be paid. CPT code 99497 Advance care planning including explanation & discussion of advance directives such as standard forms (with completion of such forms, when performed) by physician or other qualified health professional*; first 30 minutes, face-to-face with patient, family member(s) &/or surrogate; & An add-on CPT code 99498 Advance care planning including explanation & discussion of advance directives such as standard forms (with completion of such forms, when performed), by physician or other qualified health professional; each additional 30 minutes (list separately in addition to code for primary procedure). These codes encourage providers to plan & document visits solely for purpose of clarifying goals of care, & to complete necessary legal & standardized documents to establish plan of care. Provider must be face-to- face with patient, surrogate, or family. Patients are responsible for co-pays for Advance Care Planning services, if applicable, except when the services are provided as part of an Annual Wellness Visit, in which case there is no co-payment. CPT book defines this type of provider as an individual “qualified by education, training, licensure/regulation (when applicable), and facility privileging (when applicable).” The qualified health care professional, who is separate from “clinical staff” and can practice independently, may report services independently or under incident-to guidelines. Resources: http://www.nachc.org/wp-content/uploads/2015/10/Fact-sheet-on-CCM-and-ACP.pdf ; ACP FAQs https://www.cms.gov/Medicare/Medicare-Fee-for-Service- Payment/PhysicianFeeSched/Downloads/FAQ-Advance-Care-Planning.pdf ; ACoP ACP Implementation for Practices https://www.acponline.org/system/files/documents/practice-resources/business- resources/payment/medicare/advance_care_planning_toolkit.pdf ; AAFP ACP http://www.aafp.org/afp/2012/0301/p461.html#

Advance Care Planning for FQHCs Guidance of appropriate documentation would include an account of the discussion with the beneficiary (or family members and/or surrogate) regarding the voluntary nature of the encounter. Documentation should include: Confirm and review the medical facts Create an environment conducive to dialogue Allow adequate time for the patient to express their concerns and include in the documentation Establish what the patient knows Introduce or reintroduce the advanced planning service and what it entails (recognize that people handle information differently, depending on their educational level, ethnicity, culture, religion, socio-economic status, age and development level) Include who was present Completion of forms if performed Time spent face to face Plans for the next steps (additional information, tests, treatment of symptoms, referrals) should be included as needed No specific diagnosis is required for the ACP codes to be billed. It would be appropriate to report a condition for which you are counseling the beneficiary, an ICD-10 CM code to reflect an administrative examination, or a well exam diagnosis when furnished as a part of the Medicare Annual Wellness Visit (AWV). Medicare Administrative Contractors (MACs) https://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/AP8Q9P8283?OpenDocument

Depression Screening HCPCS G0444 Annual Depression Screen Co-insurance waived For FQHCs, annual screening for depression in adults is not separately payable with another face-to-face encounter on same day. This does not apply to the Initial Preventive Physical Examination (IPPE), unrelated services denoted with modifier 59, and 77X claims containing Diabetes Self-Management Training (DSMT) and/or Medical Nutrition Therapy (MNT) services. DSMT and MNT apply to FQHC’s only. However, annual screening depression by itself, when rendered as a face-to-face visit with a core practitioner, does constitute an encounter and is paid based on the all-inclusive payment rate. Primary care settings with staff-assisted depression care supports in place to assure accurate diagnosis, effective treatment, & follow-up. At a minimum level, staff-assisted supports consist of clinical staff (e.g., nurse, physician assistant) in the primary care setting who can advise the physician of screening results & who can facilitate & coordinate referrals to mental health treatment. Various screening tools are available for screening for depression. CMS does not identify specific depression screening tools. Rather, the decision to use a specific tool is at the discretion of the clinician in the primary care setting. Coverage is limited to screening services Federally Qualified Health Center (FQHC) Preventive Services Chart (Rev. 08-10-16); Medicare Benefit Policy Manual, Chapter 13 http://go.cms.gov/14BSdPN ; Medicare Claims Processing Manual, Chapter 9 ( http://go.cms.gov/1DFvBcO and Chapter 18 http://go.cms.gov/1w5l6cX ; Publication 100-03, NCD Manual, Section 210.9.