Advance Care Planning Discussion
CPT 99497
Reported when a clinician spends dedicated time discussing future care wishes and advance directives with a patient or their representative.
No national payment amount
Status I is not separately payable under the PFS.
Did Medicare pay separately for CPT 99497 in Q1 2015? Copy link
Not at a published national rate. CPT 99497 carries status I (not valid) in the Q1 2015 release. Medicare uses a different code to report and pay for this service. Treat the blank amount as unpriced, not as $0.
Source: Physician relative value file (Q1 2015) · effective January 2015 · materially updated Aug 4, 2026 · compact facts
Can you bill it with another code? Copy link
Enter a second CPT or HCPCS code billed the same date of service to check the current NCCI procedure-to-procedure edit between it and 99497.
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, ranked by patients served or total allowed dollars.
2024 Medicare fee-for-service only, national totals — Medicare Advantage, Medicaid and commercial volume are excluded, 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 the rates above come from.
Global period: what 99497's fee already covers Copy link
The global surgery concept does not apply to this code.
| Modifier | Reports |
|---|---|
| -25 | A significant, separately identifiable E/M on the same day as the procedure, beyond its usual pre- and post-operative care. |
A modifier reports what happened; it does not by itself make a service payable. Documentation has to support it.
Common questions Copy link
Why is there no payment amount for 99497?
Its status indicator is I (not valid). Medicare uses a different code to report and pay for this service. The blank is deliberate: the amount is either unknown or paid under another provision, so reading it as $0 would be wrong.
Why would a Medicare claim for 99497 be denied or paid less?
Each item below comes from a CMS indicator 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.
When does this rate change?
CMS publishes a fee schedule release every quarter (January, April, July, October), and each is versioned here. The 99497 rate last moved in Q1 2026 (+9.1% non-facility) — see its rate history or what changed each release, or get an email when a new release moves rates.
Sources: CMS Medicare Physician Fee Schedule Relative Value Files.
Saw this code on your bill? Copy link
For patientsWhat does CPT code 99497 mean?
CPT code 99497: Advance Care Planning Discussion. A common example is a patient with advancing cancer sitting down with the doctor and her husband, not to talk about the next scan, but about what she would and would not want if things got worse - whether she would accept a breathing machine, who should decide for her if she cannot, and what living well would mean to her in that situation. Often it ends with paperwork naming a decision-maker, but the value is in the conversation itself.
Billing policy Copy link
What 99497's billing-policy indicators mean. These show for every code, priced or not: 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 payment reduction applies when this procedure is billed with other procedures on the same date — each is treated as unrelated. |
| 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. |
Rate history by release Copy link
National non-facility amount for 99497 across quarterly releases. since Q1 2016 · high $86.98 in Q1 2020
| Release | Status | Non-facility | Facility |
|---|---|---|---|
| Q3 2026 Jul 1, 2026 – present | 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 Jan 1, 2024 – Mar 31, 2024 | A | $81.89 (-1.4% decrease ) | $74.56 (-1.3% 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 | — | — |
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Source & method
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This is computed from CMS's Medicare Physician Fee Schedule Q1 2015 release (schedule pfs, effective January 2015). National amounts apply a GPCI of 1.000 and leave sequestration off. The status indicator decides payability, never the RVU values, so a blank RVU stays blank. Releases are immutable: a rate retrieved for a past quarter always reflects that release. Commercial and cash-pay figures anywhere on this page are arithmetic on the Medicare amount, using commonly cited reimbursement ranges. They're illustrative, and no nationwide claims database stands behind them. Our methodology covers all of this in depth — sourcing, parsing, versioning, and how claims are cross-checked before they ship.
Description written from primary sources: CMS Medicare Physician Fee Schedule Relative Value Files. Not derived from AMA CPT descriptor text.
Use the (i) buttons next to each amount above for the exact row, columns, and math.
Cite this rate
This link keeps pointing at the Q1 2015 figures, even after a newer release lands.
CPT 99497 Medicare Physician Fee Schedule rate (Q1 2015). Localis. https://localishealth.com/cpt/99497/2015/A