How the 2027 Medicare Proposal Changes Advance Care Planning Billing for Family Medicine

What is the 2027 Medicare change to advance care planning billing?

As of July 2026, the CMS calendar year 2027 Physician Fee Schedule proposed rule would create two new HCPCS codes for advance care planning that clinical staff furnish under a physician’s direct supervision. The existing codes, 99497 and 99498, would then be limited to time the billing practitioner personally spends. For family medicine, that changes who can deliver and bill the advance care planning conversation. It is proposed, not final, with comments due September 14, 2026.

New clinical staff codes. CMS proposes two new HCPCS codes for advance care planning delivered by clinical staff under direct physician supervision. Coding summaries have referred to them with the placeholder identifiers GACP1 and GACP2.

99497 and 99498 narrow. The current codes would report only the time the billing practitioner personally spends on the conversation.

Still a proposal. Nothing is final until the 2027 final rule, and the comment window closes September 14, 2026.

What CMS Proposed for Advance Care Planning

On July 14, 2026, CMS released the calendar year 2027 Medicare Physician Fee Schedule proposed rule, designated CMS-1848-P. Inside a rule that runs well over a thousand pages, one proposal speaks directly to a service family physicians deliver often: advance care planning.

Today, advance care planning is reported with two CPT codes. 99497 covers the first 30 minutes of the face-to-face conversation, and 99498 covers each additional 30 minutes. Under current Medicare rules, only the physician or another qualified health professional who can bill Medicare independently reports these codes, even though clinical staff frequently take part in the conversation itself.

For 2027, CMS proposes to split that work. It would create two new HCPCS codes describing advance care planning furnished by clinical staff under the direct supervision of the billing physician or practitioner, and it proposes that 99497 and 99498 would report only the time the billing practitioner personally spends. In the agency’s own framing (see the CMS CY 2027 PFS proposed rule fact sheet), the aim is to distinguish and value the practitioner’s own work separately from the time clinical staff contribute.

None of this is settled. It sits inside a proposed rule, and CMS is accepting public comments through September 14, 2026, before it issues a final rule later in the year. The table below shows how the reporting would change if the proposal is finalized as written.

Element	Current (2026)	Proposed (2027)
Who furnishes the billable time	Physician or qualified health professional only	Practitioner personally, or clinical staff under direct supervision
Codes used	99497 first 30 minutes, 99498 each additional 30 minutes	99497 and 99498 for practitioner time, plus two new HCPCS codes for clinical staff time
Paired with a wellness visit	Modifier 33 waives coinsurance, once per year	Wellness visit pairing expected to continue, confirm in the final rule
Status	In effect	Proposed, comments due September 14, 2026

Does This Affect Your Family Practice?

If your practice bills advance care planning, especially alongside the Medicare Annual Wellness Visit, the proposal affects you. It matters most where clinical staff, such as a nurse or care coordinator, help lead the conversation while the physician bills 99497. Under the proposal, that clinical staff time would move to the new codes.

Family medicine is one of the specialties where advance care planning shows up naturally. The conversation often happens during a Medicare Annual Wellness Visit, when the physician and patient are already discussing goals of care, or during a chronic care visit for a patient managing several serious conditions. In many practices a nurse, social worker, or care coordinator handles part of that discussion under the physician’s supervision, and the practice reports it today under 99497.

In our experience matching family practices with billing partners, advance care planning is one of the services practices most often underbill or skip entirely, because the time and documentation rules feel fussy relative to the payment. A change that adds a second set of codes raises the stakes on getting the split right.

Because these are Medicare codes, a practice with no Medicare patients is not directly affected, though many commercial and Medicare Advantage payers follow Medicare’s lead over time. The practices with the most exposure are the ones with a meaningful Medicare panel that already fold advance care planning into wellness and chronic care visits.

How Is Advance Care Planning Billed in 2026?

In 2026, advance care planning uses CPT 99497 for the first 30 minutes and 99498 for each additional 30 minutes, reported by a physician or qualified health professional. When it is furnished with a Medicare Annual Wellness Visit and billed with Modifier 33 on the same day, by the same provider, the patient’s coinsurance and deductible are waived.

The timing rules matter. 99497 requires a minimum of about 16 minutes of face-to-face discussion before it can be reported, and 99498 is an add-on for each additional 30 minutes. The conversation covers advance directives, living wills, a health care proxy or power of attorney, and goals of care, and completing a form is optional rather than required.

The money detail practices miss most is that coinsurance waiver. Medicare treats advance care planning as an optional preventive service only when it is delivered on the same day as the Annual Wellness Visit and billed with Modifier 33. Under that pairing the patient pays nothing and the practice still gets paid. Furnished on any other day, standard Part B cost sharing applies. At the 2026 national average, Medicare pays roughly 87 dollars for 99497 before geographic adjustment, so the service is worth capturing correctly rather than leaving off the claim. The same same-day discipline governs office visit E/M coding like CPT 99213.

Why Is CMS Splitting Advance Care Planning Codes?

CMS says the new codes would more accurately distinguish and value the work a billing practitioner personally performs from the time their clinical staff spend on advance care planning. It reflects a broader push toward recognizing team-based primary care while tightening how supervised staff time is reported and paid.

The split fits a pattern in recent Medicare rulemaking. CMS has spent several years building out care-management and primary-care services that lean on clinical staff working under a physician’s supervision, from chronic care management to the newer advanced primary care management framework. Giving clinical staff advance care planning time its own codes is consistent with that direction.

There is also a valuation motive. By separating practitioner time from clinical staff time, CMS can value each at a rate that matches the resources actually used, rather than paying a single practitioner rate for work a nurse or coordinator partly performed. Whether that nets out as more or less revenue for a given practice depends on how the two new codes are ultimately valued, which the proposed rule lays out and the final rule may change.

How Does This Change Affect Your Wellness Visit Revenue?

The impact depends on how your practice staffs the conversation. If your physician personally conducts advance care planning, little changes beyond confirming the code. If clinical staff currently do part of it under 99497, that time would shift to the new codes, and the documentation has to show who spent which minutes.

Picture a common family medicine encounter. A Medicare patient comes in for an Annual Wellness Visit. The physician opens the advance care planning conversation, then a nurse continues it while the physician moves to the next room. Today the practice reports 99497 with Modifier 33 and the patient owes nothing. Under the proposal, the physician’s minutes would support 99497 and the nurse’s supervised minutes would support one of the new codes. Same conversation, two reporting streams, and a documentation standard that now has to attribute time to the right person.

The most common issue we see providers run into is not the coding rule itself, it is the documentation habit that has to change with it. If your notes do not already separate practitioner time from clinical staff time, this proposal is the reason to fix that before the rule is final. A billing partner that already handles supervised care-management time can set it up so no revenue leaks when the codes take effect.

What Family Practices Should Do Now

The proposal is not final, but the practices that prepare now will not scramble in January. Here is where to start.

1. Pull your advance care planning volume for the past year, and note how many claims were tied to a Medicare Annual Wellness Visit.
2. Identify which conversations your clinical staff lead, so you know how much time would move to the new codes.
3. Confirm your Modifier 33 and wellness visit pairing is documented correctly on every same-day claim.
4. Update your notes to record who spent the advance care planning time, the practitioner or the clinical staff.
5. Ask your billing partner whether they are tracking the proposed codes and have a transition plan.
6. Submit a comment to CMS before September 14, 2026, if the change would affect your practice.

In-House vs a Billing Partner

Whether to keep a change like this in house or hand it to a billing partner comes down to bandwidth. A single-provider practice with a sharp coder may absorb a two-code split without much trouble. A busy family medicine group already juggling wellness visits, chronic care management, and same-day sick visits often finds that one more supervised-time rule is exactly the kind of detail that slips.

Providers often come to us after a reimbursement change has already cost them, not before, usually because the in-house team did not have time to rework documentation ahead of a deadline. A billing company with real primary care experience already manages supervised clinical staff time for chronic care management and the annual wellness visit, so adding advance care planning codes is a small extension rather than a new project.

The honest test is whether your current team can tell you, today, how much of your advance care planning time is furnished by clinical staff versus the physician. If they cannot, that gap is what a specialized partner closes. For a practical framework on evaluating one, see our guide on how to find the right family medicine billing service, or start by comparing vetted options through a family medicine billing company match.

Frequently Asked Questions

Next Steps

Model your advance care planning volume and note how much of it your clinical staff furnish, so you know your exposure before the final rule.

If your practice pairs advance care planning with the Annual Wellness Visit, review your Modifier 33 documentation on those same-day claims now.

When you are ready to see whether your billing partner is prepared for the 2027 changes, we can connect you with a family medicine billing company in as little as 30 minutes.