CPT 99497 vs. Other Advance Care Planning Codes

CPT 99497 is an Evaluation and Management service for Advance Care Planning, representing a moderate-complexity encounter requiring 30 minutes face-to-face. It differs from other codes like CPT 99350, 99495, and 99496, which vary based on time spent, medical decision-making level, and specific care management scenarios, such as high complexity home visits or transitional care management services.

CPT 99497 vs. Other Advance Care Planning Codes

CPT 99497 is an Evaluation and Management (E/M) service used for Advance Care Planning (ACP). It signifies a moderate-complexity encounter and is differentiated from other ACP codes by factors such as the time spent by the provider, the level of medical decision-making involved, and the required documentation. Unlike lower-level codes that demand less time and simpler assessments, CPT 99497 typically involves more provider time and a moderate level of medical decision-making. This often includes scenarios with multiple diagnoses, medication management, or test interpretation, which necessitates more detailed documentation and generally leads to higher reimbursement.

CPT 99497 Fee Schedule

Last Verified: July 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	Advance Care Planning Evaluation and Management
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

National average reimbursement for CPT 99497 by major payers:

$96.92

$106.76

$92.78

$143.46

Preview provider-level rates for...

For billing codeCPT 99497

Payer	Code	Rate	NPI	Tax ID	State	Specialty
United	99497	$100.80	1003192311 - EL CAMPO MEMORIAL HOSPITAL	452750258 - (TX) EL CAMPO MEMORIAL HOSPITAL	TX	General Acute Care Hospital (282N00000X)
United	99497	$63.61	1528171451 - ROBERTO TREVINO, JR.	742642200	TX	Internal Medicine Physician (207R00000X)
United	99497	$122.63	1770036881 - JULIANA GOMEZ ABANTO	841033516	TX	Neurology Physician (2084N0400X)
United	99497	$111.84	1871880773 - SONIA CARVAJAL GUZMAN	271371893	TX	Internal Medicine Physician (207R00000X)
United	99497	$133.53	1023371903 - PRATIK NAIK	593259553 - ORLANDO HEALTH MEDICAL GROUP INC	TX	Internal Medicine Physician (207R00000X)
United	99497	$129.25	1538397583 - REGINA KOSHY	742109824 - (TX) AUSTIN REGIONAL CLINIC PA	TX	Cardiovascular Disease Physician (207RC0000X)
United	99497	$107.45	1295793677 - MARC PIENIEK	752254247	TX	Cardiovascular Disease Physician (207RC0000X)
United	99497	$247.91	1730147760 - KATHERINE JIN	43496618 - (MA) MILTON PEDIATRIC ASSOCIATES, LLC	MA	Pediatrics Physician (208000000X)
United	99497	$173.46	1700863560 - WENTIAN HUANG	205701172 - (TX) WENTIAN HUANG MD PHD PC	TX	Internal Medicine Physician (207R00000X)
United	99497	$98.81	1871930594 - SAAD SYED HUSSAIN	300855204	TX	Cardiovascular Disease Physician (207RC0000X)
United	99497	$91.33	1386662419 - WILLIAM GILES	823426999	TX	Internal Medicine Physician (207R00000X)
United	99497	$130.96	1396912556 - DANIEL SHEN	135596796 - MARY IMOGENE BASSETT HOSPITAL	MA	Pediatrics Physician (208000000X)
United	99497	$78.27	1275590283 - MOHAMMAD ASFOUR	481282545	TX	Neurology Physician (2084N0400X)
United	99497	$131.42	1730243270 - ALIFIYA FAKHRI	300520570 - (TX) METHODIST HOSPITAL	TX	Internal Medicine Physician (207R00000X)
United	99497	$118.51	1306338686 - MAHAN SHAHRIVARI	384109786 - (TX) UT PHYSICIANS	TX	Neurology Physician (2084N0400X)
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 Evaluation and Management Codes

The CPT 99497 code is part of the Advance Care Planning services used for Evaluation and Management. 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-CPT	High	Home Res Vst Est High Mdm 60, 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
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

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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CPT 99497 Fee Schedule

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Frequently Asked Questions

CPT 99497 vs. Other Advance Care Planning Codes