BROWSE CASE STUDIES Case Studies > Advance Care Planning Code Volumes

Advance Care Planning Code Volumes

February 2020




Utilization, Health, Commercial, Medicaid, Medicare


This analysis seeks to understand usage of the advanced care planning CPT code, 99497, from 2016 (the first year implemented) to 2018 for all Colorado counties, DOI regions, and statewide. Volume is based on the claim count for the years listed. CPT code 99497 was used because it indicates the initial conversation of advance care planning between patients and their provider. Other CPT code(s) are additional time increments of the initial conversation that go over the time listed in the description for 99497. Geography is based on the billing provider's location. As expected, the vast majority of advance care planning claims are professional claims (provider) as opposed to facility claims.
This analysis examines commercial, Medicaid, and Medicare Advantage payer types but does NOT include Medicare Fee-for-Service claims which would presumably add more volume to the results given the aging population covered by Medicare FFS. In addition, to help avoid duplication, only the primary payer was used to calculate the volume of claims.