National Government Services (NGS) has fixed a problem with advance care planning codes (ACP) 99497 and 99498, so providers in their jurisdiction should see their wrongly denied claims resolved.
As reported here earlier, on Feb. 22, NGS reported issues with those codes when used with a number of place of service (POS) codes. NGS is the Medicare Part B administrative contractor (MAC) for Connecticut, Illinois, Maine, Massachusetts, Minnesota, New Hampshire, New York, Rhode Island, Vermont and Wisconsin.
Although CMS has not given sub-regulatory guidance as to POS and ACP so far, the 2016 Physician Fee Schedule Final Rule does indicate that ACP services "are appropriately furnished in a variety of settings, depending on the condition of the patient," suggesting wide latiutude on place of service for these codes.
NGS said then that its system had been kicking out ACP claims with any but two POS codes, office (11) and independent clinic (49), and that it was fixing its system and would resoilve wrongly denied claims.
NGS announced March 17 that its adjustments have been completed -- so if you have been denied on this basis and haven't seen it reversed, you might want to call them.
The POS codes NGS will accept with ACP claims are 04 (homeless shelter), 11 (office), 12 (home), 13 (assisted living facility), 14 (group home), 19 (off campus-outpatient hospital), 20 (urgent care facility), 21 (inpatient, hospital), 22 (on campus-outpatient hospital), 23 (emergency room - hospital), 31 (skilled nrusing facility), 32 (nursing facility), 33 (custodial care facility), 34 (hospice), 49 (independent clinic), 51 (inpatient psychiatric), 52 (psychiatric facility - partial hospitalization), 53 (community mental health center), 54 (intermediate care facility/ individuals with intellectual disabilities) 55 (residential substance abuse treatment center),57 (non-residential substance abuse treatment facility),61 (comprehensive inpatient rehabilitation facility), 62 (comprehensive inpatient rehabilitation facility), 65 (end-stage renal disease treatment facility) and 71 (public health clinic).