99498
Advncd care plan addl 30 min
Advance care planning, each additional 30 minutes beyond the first 30 minutes billed under 99497. CMS 2026 wRVU 1.40, paid using the national GPCI and the 2026 conversion factor of $33.4009. Add-on only; it can never appear on a claim without 99497.
Billing guidance for 99498 is locked
- When to use it: the exact clinical situations that support billing 99498
- Documentation checklist: the 5 elements your note needs before submitting
- Common pitfalls: the 6 mistakes that get 99498 downcoded or denied
Payer notes
Medicare covers ACP with no frequency limit when medically necessary, but repeat long ACP sessions should document the change in condition or goals that warranted revisiting the plan. Cost share applies except when ACP accompanies an AWV with modifier 33. Medicare Advantage follows Medicare. Commercial coverage is common but inconsistent on the add-on specifically; some plans cap recognized units of 99498 per date of service. The wRVU on a fully captured 76-minute ACP encounter (99497 + 2 x 99498) is 4.30, which exceeds a 99215, making accurate time capture worthwhile for clinicians doing serious-illness care.