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.
When to use it
Use 99498 when a face-to-face advance care planning discussion runs past the first 30 minutes covered by 99497. The CMS time bands follow the midpoint rule: 99497 alone covers 16 to 45 minutes of ACP time, 99497 plus one unit of 99498 covers 46 to 75 minutes, and 99497 plus two units covers 76 to 105 minutes.
Full guidance
The discussion covers the explanation and discussion of advance directives (health care proxy, living will, MOLST/POLST), with or without completing the forms, by the physician or QHP face-to-face with the patient, a family member, or a surrogate. Long ACP conversations that earn the add-on are common in newly diagnosed serious illness (metastatic cancer, advanced heart failure, ALS), at transitions like starting dialysis or considering hospice, and in family meetings where the patient lacks capacity and multiple decision makers need to align. ACP is time-based and separately billable on the same day as an E/M visit, an AWV, or monthly care management, provided the ACP minutes are carved out and documented separately.
Documentation checklist
- ✓Total face-to-face ACP time on the date of service, documented as minutes. The first 99498 unit requires at least 46 total minutes; a second unit requires at least 76.
- ✓Content of the discussion: what was explained (proxy, living will, MOLST/POLST, code status), who participated (patient, family member, surrogate), and decisions made or deferred.
- ✓Voluntary participation. Note that the patient (or surrogate) agreed to the discussion; ACP is always voluntary for the patient.
- ✓Completion of forms is not required, but if directives were completed or changed, record which documents.
- ✓If billed alongside an E/M on the same date, the E/M time and the ACP time must be separately documented and must not overlap.
Common pitfalls
- !Billing 99498 without 99497 on the same claim. It is structurally an add-on and denies automatically when alone.
- !Billing the add-on at 31 to 45 minutes. The midpoint rule requires 46 total minutes before the first 99498 unit; rounding up from 40 minutes is the most common ACP audit finding.
- !Counting non-face-to-face time. Chart preparation, form scanning, and documentation after the patient leaves do not count toward ACP time for 99497 or 99498.
- !Double-counting the ACP minutes toward the same-day E/M level or toward prolonged services (99417 or G2212). Each time-based code needs its own exclusive minutes.
- !Missing modifier 33 when ACP is performed on the same day as an AWV (G0438 or G0439). With modifier 33 Medicare waives the deductible and coinsurance; without it the patient gets a bill and the front desk gets a complaint.
- !Billing ACP with 99483 (cognitive assessment and care planning). ACP is bundled into 99483 and cannot be reported separately on the same date.
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.