CPT 99497 Fee Schedule
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.
| 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 | Moderate |
National average reimbursement for CPT 99497 by major payers:
$96.92
$106.76
$92.78
$148.47
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 99497 | ||||||
United | 99497 | $143.52 | 1700044013 - MARC ELIESON | 742967081 - (TX) HILLCREST PHYSICIAN SERVICES | TX | Internal Medicine Physician (207R00000X) |
United | 99497 | $166.52 | 1003807447 - TWINKLE MYINT | 752613493 - TEXAS HEALTH PHYSICIANS GROUP | TX | Internal Medicine Physician (207R00000X) |
United | 99497 | $91.48 | 1235321126 - CLAYTON MCCUAN | 462718719 - ACCESS TELECARE PLLC | TX | Internal Medicine Physician (207R00000X) |
United | 99497 | $173.46 | 1255860391 - SREEVANI KUNCHAM, MD, PA | 820978110 - (TX) SREEVANI KUNCHAM MD PA | TX | Internal Medicine Physician (207R00000X) |
United | 99497 | $64.37 | 1235294232 - EL PASO CARDIOLOGY ASSOCIATES, P.A. | 742844275 - (TX) EL PASO CARDIOLOGY ASSOCIATES, P.A. | TX | Cardiovascular Disease Physician (207RC0000X) |
United | 99497 | $68.41 | 1306023049 - PRIMARY CARE INTERNAL MEDICINE PLLC, MARK DOERNER SOLE MBR | 352322216 - (TX) PRIMARY CARE INTERNAL MEDICINE PLLC | TX | Internal Medicine Physician (207R00000X) |
United | 99497 | $131.42 | 1184979981 - GABRIELA ORGERON | 300520570 - (TX) METHODIST HOSPITAL | TX | Cardiovascular Disease Physician (207RC0000X) |
United | 99497 | $215.02 | 1821625583 - SANDRA GARCIA | 756002868 | TX | Internal Medicine Physician (207R00000X) |
United | 99497 | $78.27 | 1275590283 - MOHAMMAD ASFOUR | 481282545 | TX | Neurology Physician (2084N0400X) |
United | 99497 | $166.25 | 1790096998 - JUNAID KALIA | 861441258 | TX | Neurology Physician (2084N0400X) |
United | 99497 | $69.58 | 1164510392 - NEUROLOGY & NEUROPHYSIOLOGY, PA, NEURO-NEURO | 742939553 - (TX) NEUROLOGY NEUROPHYSIOLOGY PA | TX | Neurology Physician (2084N0400X) |
United | 99497 | $135.69 | 1528057742 - PRATIMA BAKSHI | 752536818 - HEALTHTEXAS PROVIDER NETWORK | TX | Internal Medicine Physician (207R00000X) |
United | 99497 | $200.52 | 1720646862 - MARY KELLEY | 931261079 - (OR) THE ORTHOPEDIC AND NEUROSURGICAL CENTER OF THE CASCADES | TX | Neurology Physician (2084N0400X) |
United | 99497 | $104.19 | 1821409673 - RAMCHARITHA KANDIKATLA | 452654166 | TX | Internal Medicine Physician (207R00000X) |
United | 99497 | $103.76 | 1518933811 - SYED ZAIDI | 472876108 | TX | Internal Medicine Physician (207R00000X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 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 |
|---|---|---|
| 99350 | High | Home Or Residence Visit For The Evaluation And Management Of An Established Patient Which Requires A Medically Appropriate History And/Or Examination And High Level Of Medical Decision Making. When Using Total Time On The Date Of The Encounter For Code Selection 60 Minutes Must Be Met Or Exceeded.(Desc Rvsd 1/1/23) |
| 99495 | Moderate | Transitional Care Management Services With The Following Required Elements: Communication (Directcontact Telephone Electronic) With The Patient And/Or Caregiver Within 2 Business Days Of Discharge At Least Moderate Level Of Medical Decision Making During The Service Period Face-To-Face Visit Within 14 Calendar Days Of Discharge (Desc Rvsd 1/1/23) |
| 99496 | High | Transitional Care Management Services With The Following Required Elements: Communication (Directcontact 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 (Desc Rvsd 1/1/23) |
| 99497 | Low | Advance Care Planning Including The Explanation And Discussion Of Advacne 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 |
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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