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See a sample rate comparisonCPT 99497 Fee Schedule
Last Verified: September 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Advncd Care Plan 30 Min, Advance Care Planning Including The Explanation And Discussion Of Advance Directives Such As Standard Forms With Completion Of Such Forms When Performed By The Physician Or Other Qualified Health Care Professional First 30 Minutes Face To Face With The Patient Family Member S And Or Surrogate
| Key Fact | Detail |
|---|---|
| Service Type | Evaluation and Management Advance Care Planning |
| Common Place of Service | 11 - Office 21 - Inpatient Hospital 99 - Other POS |
| Common Modifiers | None 33 - Preventive Services 25 - Significant, separately identifiable E/M service same day |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 99497 |
| Medicaid Fee Schedule | View Medicaid rates for 99497 |
National average reimbursement for CPT 99497 by major payers:
$96.92
$106.76
$92.78
$143.46
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CPT 99497
5 of 25 sample ratesHigher to lower in this preview
Katherine Jin
Milton Pediatric Associates, LLC
$247.91Published rateManisha Shah
Southwest Health System Inc
$139.78Published rateMahan Shahrivari
Ut Physicians
$118.51Published rateWilliam Giles
$91.33Published rateRoberto Trevino, Jr.
$63.61Published rate
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See a sample payer proposalCPT 99497 vs. Other Advance Care Planning Codes
The CPT 99497 code is part of the Evaluation and Management services used for Advance Care Planning. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 99497 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 99495-CPT | Moderate | Care Management, Assessment Of And Care Planning For A Patient With Cognitive Impairment Requiring An Independent Historian In The Office Or Other Outpatient Home Or Domiciliary Or Rest Home With All Of The Following Required Elements: Cognition-Focused Evaluation Including A Pertinent History And Examination Medical Decision Making Of Moderate Or High Complexity Functional Assessment (Eg Basic And Instrumental Activities Of Daily Living) Including Decision-Making Capacity Use Of Standardized |
| 99496-CPT | High | Transj Care Mgmt High F2f 7d, Transitional Care Management Services With The Following Required Elements Communication Direct Contact Telephone Electronic With The Patient And Or Caregiver Within 2 Business Days Of Discharge High Level Of Medical Decision Making During The Service Period Face To Face Visit Within 7 Calendar Days Of Discharge |
| 99497-CPT | Low | Advncd Care Plan 30 Min, Advance Care Planning Including The Explanation And Discussion Of Advance Directives Such As Standard Forms With Completion Of Such Forms When Performed By The Physician Or Other Qualified Health Care Professional First 30 Minutes Face To Face With The Patient Family Member S And Or Surrogate |
| 99498-CPT | Low | Advncd Care Plan Addl 30 Min, Advance Care Planning Including The Explanation And Discussion Of Advance Directives Such As Standard Forms With Completion Of Such Forms When Performed By The Physician Or Other Qualified Health Care Professional Each Additional 30 Minutes List Separately In Addition To Code For Primary Procedure |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99497. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99497 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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