CPT 99497
Advance Care Planning
Unable to determine from available CMS sources
99497 · PFS Q1 2015 · Historical
No national PFS rate in Q1 2015
Status I is not separately payable under the PFS.
CPT 99497 has no published national rate. It carries status I (not valid) in the Q1 2015 release. Medicare uses a different code to report and pay for this service. The blank amount means unpriced, not $0.
PFS status evidence
Inspect PFS status evidence
- Code
- 99497
- Release
- Q1 2015, revision 1
- Result
- Unable to determine from available CMS sources
Citations
-
Shows this code’s PFS status (I). Result: Unable to determine from available CMS sources.
Physician relative value file (PPRRVU)Q1 2015 · revision 1
Latest revision of this release
Release period: January 1 – March 31, 2015
This PFS record alone does not establish a $0 allowance or a coverage determination. Any amount from another schedule needs its own evidence.
Record details
PPRRVU15_V1223c.csv in rvu15a.zip (row 16,073)- hcpcs (col 1)
- 99497
- modifier (col 2)
- blank
- status_code (col 4)
- I
SHA-256: d600c52a7d5f75737599c9a879cc0ffc8c85766bee82e9e2eadf49af364314d2
Why is there no national PFS amount for 99497?
Its status indicator is I (not valid). Medicare uses a different code to report and pay for this service. Status I is not separately payable under the PFS.
Payment considerations Copy link
Here are the inputs and payment rules that apply to this code. Each link takes you to the detail below.
Other payment indicators (10)
Facility/non-facility: Not determined, Professional/technical component: Does not apply, Bilateral adjustment: Does not apply, Multiple-procedure reduction: Does not apply, Assistant/co-surgeon treatment: Does not apply, Global surgery: Does not apply, NCCI same-day edits: Not determined, MUE behavior: Not determined, Other fee-schedule routing: Does not apply, Contractor pricing: Does not apply.
Why would a Medicare claim for 99497 be denied or paid less?
These come from CMS indicators on this page, not general billing advice.
- Its status indicator is I (not valid)—Medicare uses a different code to report and pay for this service. See status indicators
- Bilateral surgery: no bilateral adjustment. See billing policy
- Assistant at surgery: restricted without documentation. See billing policy
- Co-surgeons: not permitted. See billing policy
- Team surgery: not permitted. See billing policy
Payer-specific coverage and documentation rules live outside these files, so a claim that clears every check here can still be denied on other grounds.
Why a 99497 line may not pay separately Copy link
CMS publishes no separately payable amount for 99497 in this release, so reconciling the line means establishing which status governed the date of service rather than chasing a fee-schedule difference.
What to check
- Confirm the status that governed the date of service before working this line as a short payment—CMS publishes no separately payable fee-schedule amount for it in this release.
- Check for documentation on file before appealing an assistant-at-surgery denial: payment on the -80 or -AS line is restricted for this procedure unless medical necessity is established.
- Reprice the line against the release, locality, setting, modifier and participation status that applied to the date of service before treating any difference as an underpayment.
Codes to compare
National Q1 2015 amounts at GPCI 1.000. A blank means this schedule does not publish a payable PFS amount.
Sources: CMS Medicare Physician Fee Schedule Relative Value Files; CMS Medicare Physician Fee Schedule Relative Value Files (status indicator field); 42 USC 1395w-4(i)(2) (SSA §1848(i)(2))—Assistants-at-surgery.
Which billing rules and modifiers apply? Copy link
Global period: what 99497's fee already covers Copy link
The global surgery concept does not apply to this code.
Billing policy Copy link
These billing-policy indicators explain how 99497 is treated. They apply whether the code is nationally priced or carrier-priced: a restriction like "bilateral not allowed" still matters on a carrier-priced code.
| Policy | Value | What it means |
|---|---|---|
| Bilateral surgery | 0 | No bilateral adjustment. The 150% bilateral payment adjustment does not apply to this procedure. |
| Assistant at surgery | 0 | Restricted without documentation. Payment for an assistant at surgery is restricted for this procedure unless supporting documentation establishes medical necessity. |
| Co-surgeons | 0 | Not permitted. Medicare does not recognize co-surgeons (modifier 62) for this procedure. |
| Team surgery | 0 | Not permitted. Medicare does not recognize a surgical team (modifier 66) for this procedure. |
| Multiple procedures | 0 | No reduction. No multiple-procedure reduction applies when this procedure is billed with others on the same date; each is paid at its full fee schedule amount. |
| Professional/technical split | 0 | No PC/TC split. This is a physician service code; the professional/technical split does not apply, and the code is billed as a single service. |
Can you bill it with another code? Copy link
Check a pair of codes Copy link
Enter a second CPT or HCPCS code billed on the same date of service. We'll check the current NCCI procedure-to-procedure edit for the pair.
How has it changed? Copy link
Rate history by release Copy link
National Office (non-facility) amount for 99497 across quarterly releases. +1.1% increase since Q1 2016 · peak $86.98 in Q1 2020
| Release | Status | Office | Facility |
|---|---|---|---|
| Q4 2026 takes effect Oct 1, 2026 | A | $86.84 (0.0% no change ) | $65.80 (0.0% no change ) |
| Q3 2026 Jul 1, 2026 – Sep 30, 2026 | A | $86.84 (0.0% no change ) | $65.80 (0.0% no change ) |
| Q2 2026 Apr 1, 2026 – Jun 30, 2026 | A | $86.84 (0.0% no change ) | $65.80 (0.0% no change ) |
| Q1 2026 Jan 1, 2026 – Mar 31, 2026 | A | $86.84 (+9.1% increase ) | $65.80 (-9.2% decrease ) |
| Q4 2025 Oct 1, 2025 – Dec 31, 2025 | A | $79.57 (0.0% no change ) | $72.46 (0.0% no change ) |
| Q3 2025 Jul 1, 2025 – Sep 30, 2025 | A | $79.57 (0.0% no change ) | $72.46 (0.0% no change ) |
| Q2 2025 Apr 1, 2025 – Jun 30, 2025 | A | $79.57 (0.0% no change ) | $72.46 (0.0% no change ) |
| Q1 2025 Jan 1, 2025 – Mar 31, 2025 | A | $79.57 (-2.8% decrease ) | $72.46 (-2.8% decrease ) |
| Q4 2024 Oct 1, 2024 – Dec 31, 2024 | A | $81.89 (0.0% no change ) | $74.56 (0.0% no change ) |
| Q3 2024 Jul 1, 2024 – Sep 30, 2024 | A | $81.89 (0.0% no change ) | $74.56 (0.0% no change ) |
| Q2 2024 Apr 1, 2024 – Jun 30, 2024 | A | $81.89 (0.0% no change ) | $74.56 (0.0% no change ) |
| Q1 2024 Mar 9, 2024 – Mar 31, 2024 | A | $81.89 (+1.7% increase ) | $74.56 (+1.6% increase ) |
| Q1 2024 Jan 1, 2024 – Mar 8, 2024 | A | $80.55 (-3.0% decrease ) | $73.35 (-2.9% decrease ) |
| Q4 2023 Oct 1, 2023 – Dec 31, 2023 | A | $83.02 (0.0% no change ) | $75.57 (0.0% no change ) |
| Q3 2023 Jul 1, 2023 – Sep 30, 2023 | A | $83.02 (0.0% no change ) | $75.57 (0.0% no change ) |
| Q2 2023 Apr 1, 2023 – Jun 30, 2023 | A | $83.02 (0.0% no change ) | $75.57 (0.0% no change ) |
| Q1 2023 Jan 1, 2023 – Mar 31, 2023 | A | $83.02 (-2.9% decrease ) | $75.57 (-2.9% decrease ) |
| Q4 2022 Oct 1, 2022 – Dec 31, 2022 | A | $85.48 (0.0% no change ) | $77.86 (0.0% no change ) |
| Q3 2022 Jul 1, 2022 – Sep 30, 2022 | A | $85.48 (0.0% no change ) | $77.86 (0.0% no change ) |
| Q2 2022 Apr 1, 2022 – Jun 30, 2022 | A | $85.48 (0.0% no change ) | $77.86 (0.0% no change ) |
| Q1 2022 Jan 1, 2022 – Mar 31, 2022 | A | $85.48 (-0.4% decrease ) | $77.86 (-0.8% decrease ) |
| Q4 2021 Oct 1, 2021 – Dec 31, 2021 | A | $85.84 (0.0% no change ) | $78.51 (0.0% no change ) |
| Q3 2021 Jul 1, 2021 – Sep 30, 2021 | A | $85.84 (0.0% no change ) | $78.51 (0.0% no change ) |
| Q2 2021 Apr 1, 2021 – Jun 30, 2021 | A | $85.84 (0.0% no change ) | $78.51 (0.0% no change ) |
| Q1 2021 Jan 1, 2021 – Mar 31, 2021 | A | $85.84 (-1.3% decrease ) | $78.51 (-2.4% decrease ) |
| Q4 2020 Oct 1, 2020 – Dec 31, 2020 | A | $86.98 (0.0% no change ) | $80.48 (0.0% no change ) |
| Q3 2020 Jul 1, 2020 – Sep 30, 2020 | A | $86.98 (0.0% no change ) | $80.48 (0.0% no change ) |
| Q2 2020 Apr 1, 2020 – Jun 30, 2020 | A | $86.98 (0.0% no change ) | $80.48 (0.0% no change ) |
| Q1 2020 Jan 1, 2020 – Mar 31, 2020 | A | $86.98 (+0.6% increase ) | $80.48 (+0.1% increase ) |
| Q4 2019 Oct 1, 2019 – Dec 31, 2019 | A | $86.49 (0.0% no change ) | $80.37 (0.0% no change ) |
| Q3 2019 Jul 1, 2019 – Sep 30, 2019 | A | $86.49 (0.0% no change ) | $80.37 (0.0% no change ) |
| Q2 2019 Apr 1, 2019 – Jun 30, 2019 | A | $86.49 (0.0% no change ) | $80.37 (0.0% no change ) |
| Q1 2019 Jan 1, 2019 – Mar 31, 2019 | A | $86.49 (+0.5% increase ) | $80.37 (-0.3% decrease ) |
| Q4 2018 Oct 1, 2018 – Dec 31, 2018 | A | $86.04 (0.0% no change ) | $80.64 (0.0% no change ) |
| Q3 2018 Jul 1, 2018 – Sep 30, 2018 | A | $86.04 (0.0% no change ) | $80.64 (0.0% no change ) |
| Q2 2018 Apr 1, 2018 – Jun 30, 2018 | A | $86.04 (0.0% no change ) | $80.64 (0.0% no change ) |
| Q1 2018 Jan 1, 2018 – Mar 31, 2018 | A | $86.04 (+3.8% increase ) | $80.64 (+3.5% increase ) |
| Q4 2017 Oct 1, 2017 – Dec 31, 2017 | A | $82.90 (0.0% no change ) | $77.88 (0.0% no change ) |
| Q3 2017 Jul 1, 2017 – Sep 30, 2017 | A | $82.90 (0.0% no change ) | $77.88 (0.0% no change ) |
| Q2 2017 Apr 1, 2017 – Jun 30, 2017 | A | $82.90 (0.0% no change ) | $77.88 (0.0% no change ) |
| Q1 2017 Jan 1, 2017 – Mar 31, 2017 | A | $82.90 (-3.5% decrease ) | $77.88 (-2.0% decrease ) |
| Q4 2016 Oct 1, 2016 – Dec 31, 2016 | A | $85.93 (0.0% no change ) | $79.49 (0.0% no change ) |
| Q3 2016 Jul 1, 2016 – Sep 30, 2016 | A | $85.93 (0.0% no change ) | $79.49 (0.0% no change ) |
| Q2 2016 Apr 1, 2016 – Jun 30, 2016 | A | $85.93 (0.0% no change ) | $79.49 (0.0% no change ) |
| Q1 2016 Jan 1, 2016 – Mar 31, 2016 | A | $85.93 | $79.49 |
| Q4 2015 Oct 1, 2015 – Dec 31, 2015 | I | — | — |
| Q3 2015 Jul 1, 2015 – Sep 30, 2015 | I | — | — |
| Q2 2015 Apr 1, 2015 – Jun 30, 2015 | I | — | — |
| Q1 2015 Jan 1, 2015 – Mar 31, 2015 | I | — | — |
When does this rate change?
CMS publishes a fee schedule release every quarter (January, April, July, October), and each is versioned here. See what changed each release, or get an email when a new release moves rates.
The 99497 rate last moved in Q1 2026. See its rate history.
Sources: CMS Medicare Physician Fee Schedule Relative Value Files.
Usage and related codes Copy link
How often 99497 is billed Copy link
Across Original Medicare in CY2024, 99497 ranked #87 of the 7,879 CPT codes billed to Medicare that year, by patients served or total allowed dollars.
2024 Medicare fee-for-service national totals. They exclude Medicare Advantage, Medicaid and commercial volume, so real-world use runs higher. This is a calendar-year snapshot from the CMS Physician & Other Practitioners dataset, on a different cycle from the Q1 2015 fee schedule above.
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Source & method
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This page uses CMS's Medicare Physician Fee Schedule Q1 2015 release (effective January 2015). National baselines use GPCI 1.000 and exclude sequestration. Whether a national amount exists depends on the status and CMS’s payment instructions; blank RVUs are never treated as zero. Past releases are never edited, so these sources stay valid after CMS publishes a newer one. Our methodology explains sourcing, parsing, versioning, and how we cross-check claims before we publish them.
Use the (i) buttons next to each amount above for the exact row, columns, and math.
Cite this rate
The citation names the release, so anyone can check it even after CMS publishes a newer one.
CPT 99497 National PFS baseline: No national PFS rate (Q1 2015; participating; whole service; GPCI 1.000; sequestration excluded). Localis. https://localishealth.com/cpt/99497/2015/A