99497
Care Mgmt / CounselCMS status: AAdvance care planning, first 30 minutes of face-to-face discussion with patient, family, or surrogate.
Work RVU
1.50
Practice RVU
1.01
Malpractice RVU
0.09
Total RVU
2.60
2026 Medicare payment
$86.84
National GPCI = 1.000 · Conversion factor $33.4009 · Non-facility
Model this code
Drop 99497 into a scenario to see how unit volume rolls up to annual wRVUs, gross collections, and bonus.
Open in calculator →When to use it
Discussion of advance directives, healthcare proxy, goals of care. Patient must be present at start unless meeting with a surrogate is explicitly billed.
Documentation checklist
- ✓Time spent in the discussion (minimum 16 min for the first unit).
- ✓Topics discussed (directives, POA, MOLST, code status).
- ✓Patient or surrogate identified.
- ✓No requirement to complete a directive — discussion alone qualifies.
Common pitfalls
- !Counting time before the conversation actually started (chart review prep does not count).
- !Billing on the same day as 99490 (CCM) without separate documentation.
Common modifiers
33 (when bundled with AWV to waive cost share)
Common ICD-10 pairings
Z71.89
Payer notes
Patient cost share is waived when billed same day as G0438/G0439 with modifier 33.
Pairs well with
Educational reference, not billing or legal advice. Verify against your payer contracts and your compliance team before submission.