CPT 99498 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 | Advance Care Planning Evaluation and Management |
| 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 | Low |
| Medicare Fee Schedule | View Medicare rates for 99498 |
National average reimbursement for CPT 99498 by major payers:
$87.20
$93.36
$85.77
$125.97
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 99498 | $98.02 | 1184731176 - JOHN ERIKSON | 741586031 | TX | Cardiovascular Disease Physician (207RC0000X) |
United | 99498 | $103.73 | 1386853901 - ENRIQUE GARCIA-SAYAN | 760459500 - U T PHYSICIANS | TX | Cardiovascular Disease Physician (207RC0000X) |
United | 99498 | $145.44 | 1194946244 - TANISHA HAMILTON | 752536818 - HEALTHTEXAS PROVIDER NETWORK | TX | Internal Medicine Physician (207R00000X) |
United | 99498 | $60.91 | 1841389087 - MIGUEL MOLINAS | 742952805 - (TX) MIGUEL ANGEL MOLINAS MD PA | TX | Internal Medicine Physician (207R00000X) |
United | 99498 | $68.20 | 1821175407 - THOMAS DANIEL | 462228135 - (TX) YUN W KIM MD PA | TX | Internal Medicine Physician (207R00000X) |
United | 99498 | $79.95 | 1609530013 - M MEDICAL GROUP SE LLC | 873189230 - (TX) M MEDICAL GROUP SE LLC | TX | Internal Medicine Physician (207R00000X) |
United | 99498 | $75.23 | 1346369253 - SAN ANTONIO INTERNAL MEDICINE GROUP PA | 742106698 - (TX) SAN ANTONIO INTERNAL MEDICINE GROUP, P.A. | TX | Internal Medicine Physician (207R00000X) |
United | 99498 | $112.55 | 1699092304 - BILLY GAO | 760385980 - MHS PHYSICIANS OF TEXAS | TX | Neurology Physician (2084N0400X) |
United | 99498 | $57.43 | 1760700330 - NEUROPHYSIOLOGY | 461082525 - (TX) NEUROPHYSIOLOGY | TX | Neurology Physician (2084N0400X) |
United | 99498 | $127.94 | 1811952427 - JOHN HARVEY | 752600873 - (TX) SHANNON CLINIC | TX | Internal Medicine Physician (207R00000X) |
United | 99498 | $145.78 | 1639111883 - EDWARD NELSON | 752613493 - TEXAS HEALTH PHYSICIANS GROUP | TX | Internal Medicine Physician (207R00000X) |
United | 99498 | $104.02 | 1710419825 - LAUREN RASH | 741613878 - (TX) BAYLOR COLLEGE OF MEDICINE | TX | Internal Medicine Physician (207R00000X) |
United | 99498 | $85.29 | 1003134479 - SHAHBAZ AHMAD | 813226324 - (TX) COMPREHENSIVE ID CARE | TX | Internal Medicine Physician (207R00000X) |
United | 99498 | $87.77 | 1417931155 - MICHAEL RAIZNER | 741941710 | TX | Cardiovascular Disease Physician (207RC0000X) |
United | 99498 | $91.37 | 1174058325 - NEHA GANDHI | 751739707 - (TX) TEXOMA NEUROLOGY ASSOCIATES, P.A. | 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 99498 vs. Other Evaluation and Management Codes
The CPT 99498 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 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-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 |
| 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 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.
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