CPT 99498 Fee Schedule

Last Verified: November 2025

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.

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 Additional30 Minutes (List Separately In Addition To Code For Primary Procedure)

Key Fact	Detail
Service Type	• Evaluation and Management • Advance Care Planning
Common Place of Service	• 21 - Inpatient Hospital • None • 11 - Office
Common Modifiers	• None • 25 - Significant, separately identifiable E/M service same day • 33 - Preventive Services
Complexity Level	Moderate

National average reimbursement for CPT 99498 by major payers:

$87.20

$93.36

$85.77

$130.46

Preview provider-level rates for...

For billing codeCPT 99498

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 99498
United	99498	$79.04	1942289590 - BERTRON BROWN	760422435 - C H WILKINSON PHYSICIAN NETWORK	TX	Internal Medicine Physician (207R00000X)
United	99498	$79.58	1356515845 - MANAVJOT SIDHU	932191049 - (TX) ELITECARE CARDIOLOGY VASCULAR CENTER PLLC	TX	Cardiovascular Disease Physician (207RC0000X)
United	99498	$153.13	1073877700 - OLUBUKOLA OKORO	812209406 - (TX) RESCUEMD PLLC	TX	Internal Medicine Physician (207R00000X)
United	99498	$76.15	1467510990 - VASISHTA PATEL	760329950 - (TX) REGIONAL NEURODIAGNOSTIC CENTER, PA	TX	Neurology Physician (2084N0400X)
United	99498	$56.97	1619157492 - PRABHUGOUDA PATIL	821369101 - (TX) UNITED CARE PHYSICIANS GROUP PLLC	TX	Internal Medicine Physician (207R00000X)
United	99498	$75.12	1104175009 - VICTOR NJOKU	451834769	TX	Internal Medicine Physician (207R00000X)
United	99498	$153.13	1356495857 - PURVI SANGHVI	462268793 - (TX) PREMIER CARE INTERNAL MEDICINE	TX	Internal Medicine Physician (207R00000X)
United	99498	$57.02	1639724164 - PREMIER CARDIOLOGY CLINIC PLLC	842412647 - (TX) PREMIER CARDIOLOGY CLINIC, PLLC	TX	Cardiovascular Disease Physician (207RC0000X)
United	99498	$68.54	1750759759 - JOSE TORRIJOS	872473213 - (TX) SOTX HOSPITALIST ASSOCIATES PLLC	TX	Internal Medicine Physician (207R00000X)
United	99498	$73.33	1790218592 - SABA RAJA	814329341 - (TX) VANGUARD INPATIENT PHYSICIAN PLLC	TX	Internal Medicine Physician (207R00000X)
United	99498	$153.13	1861416851 - ANITA KHETAN	474482186 - (TX) ABKSW PREFERRED HEALTH PARTNERS	TX	Internal Medicine Physician (207R00000X)
United	99498	$145.44	1194946244 - TANISHA HAMILTON	752536818 - HEALTHTEXAS PROVIDER NETWORK	TX	Internal Medicine Physician (207R00000X)
United	99498	$100.51	1659509990 - SRIDHAR VENKATACHALAM	752616977 - CHRISTUS TRINITY CLINIC	TX	Cardiovascular Disease Physician (207RC0000X)
United	99498	$134.66	1801242086 - MICHAEL POPESCU	721529332 - (PA) HIGHMARK HEALTH	TX	Internal Medicine Physician (207R00000X)
United	99498	$87.77	1417931155 - MICHAEL RAIZNER	741941710	TX	Cardiovascular Disease Physician (207RC0000X)
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

Want to see your competitors' rates?

Start your trial today to unlock complete access to provider rates and fee schedules in your area.

Run a free sample report

Here's what you can do with PayerPrice

Renegotiate your managed care contracts

Benchmark your current rates against market averages to identify opportunities for rate optimization.

Prospect for new business using fee schedules

Access every provider's negotiated rates for every billing code in your market to inform your prospecting strategies.

Integrate real-time payer data into your workflows

Automatically keep fee schedules up-to-date without adding yet another log-in to your insurance systems. Connect via API or SQL.

Explore state-level rates for free

PayerPrice shows you the exact negotiated rates that insurers publish under federal transparency rules.
We display the raw data directly from insurers' files, giving you the same information they make public. Learn more about Price Transparency.

CPT 99498 vs. Other Advance Care Planning Codes

The CPT 99498 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 99498 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)
99498	Low	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 Additional30 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 99498. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the 99498 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.

FREE SAMPLE MARKET COMPARISON

Let's review your payer contracts side-by-side with the market.

Bring your top codes (like CPT 99498) and we'll show you how you compare in 15 minutes or less.

Schedule a Demo

Medicare Reimbursement Lookup Tool

PayerPrice provides a free medicare lookup tool for physician fee schedule, drug ASP, MS-DRG weights, anesthesia conversion factors and other medicare related data.

Search Medicare Rates