Care Mgmt / Counsel · CMS status A
99497
Advncd care plan 30 min
Advance care planning (ACP) discussion with the patient, family member, or surrogate, first 30 minutes of face-to-face conversation. CMS 2026 wRVU 1.50. Use 99498 for each additional 30 minutes beyond the first.
Work RVU
1.50
2026 Medicare pays
$86.84
National GPCI · non-facility · CF $33.4009
RVU anatomyWork 1.50 + Practice 1.01 + Malpractice 0.09 = 2.60 total
Work (your effort)Practice expenseMalpractice
Billing guidance for 99497 is locked
- When to use it: the exact clinical situations that support billing 99497
- Documentation checklist: the 6 elements your note needs before submitting
- Common pitfalls: the 5 mistakes that get 99497 downcoded or denied
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Common modifiers
33 (when bundled with AWV to waive cost share)
Common ICD-10 pairings
Z71.89Z51.5Z66
Payer notes
Medicare and Medicare Advantage plans pay 99497 with no cost share when billed with modifier 33 on the same day as an AWV; otherwise standard cost share applies. Commercial payers including BCBS and Aetna typically reimburse 99497 with their standard E/M fee schedule. Some commercial plans require documentation of the patient's expressed wish to discuss ACP; routine documentation should record patient request or clinician initiation.
Pairs well with
Educational reference, not billing or legal advice. Verify against your payer contracts and your compliance team before submission.