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. Use 99498 for each additional 30 minutes beyond the first.
Published by RVUDoc. Numeric data: CMS RVU26C, effective 2026-07-01. Page updated 2026-09-23. Calculation limits and editorial policy.
Fee-schedule estimate before claim adjustments. Coverage, setting and payer rules still apply.
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
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.
Related codes
These include alternative services and possible add-ons. Listing codes together does not establish that they can be billed together; check the applicable edits and payer policy.
See what 99497 adds to your year
Add it to the wRVU calculator with your own volume, or paste a note and let the chart audit check your coding.