{
    "code": "99497",
    "coding_system": "CPT",
    "canonical_url": "https://localishealth.com/cpt/99497/2015/A",
    "release_specific_url": "https://localishealth.com/cpt/99497/2015/D",
    "description": "A face-to-face conversation with a patient, family member, or surrogate about the care they would want if they became too ill to speak for themselves. The clinician explains options such as life support, resuscitation, and comfort-focused care, and may help complete documents like an advance directive or healthcare proxy - though no form has to be signed for the discussion to count. This code covers the first block of that discussion, around half an hour; longer conversations continue with a separate add-on. It is a counselling service, not a procedure, and it can happen alongside a regular visit or as the entire reason for the appointment.",
    "answer": {
        "question": "Did Medicare pay separately for CPT 99497 in Q4 2015?",
        "text": "Not at a published national rate. CPT 99497 carries status I (not valid) in the Q4 2015 release. Medicare uses a different code to report and pay for this service. Treat the blank amount as unpriced, not as $0."
    },
    "release": {
        "schedule": "pfs",
        "year": 2015,
        "quarter": "D",
        "label": "Q4 2015",
        "effective": "October 1 – December 31, 2015",
        "revision": 1
    },
    "status": {
        "code": "I",
        "non_facility_payable": false,
        "facility_payable": false
    },
    "national_rates_usd": {
        "office_non_facility": null,
        "facility": null,
        "sequestration_applied": false,
        "gpci": 1
    },
    "rvus": {
        "work": null,
        "practice_expense_non_facility": null,
        "practice_expense_facility": null,
        "malpractice": null
    },
    "formula": "(work_rvu × work_gpci + pe_rvu × pe_gpci + mp_rvu × mp_gpci) × conversion_factor",
    "conversion_factor": 35.9335,
    "source": {
        "label": "Physician relative value file (Q4 2015)",
        "cms_url": "https://www.cms.gov/medicare/medicare-fee-for-service-payment/physicianfeesched/downloads/rvu15d.zip",
        "local_source_url": "https://localishealth.com/sources/physician-fee-schedule/2015/D",
        "file": "PPRRVU15_OCT05_V1001.csv",
        "row": 16085,
        "sha256": "302a55af716b26df5b42e80da7b2bd7cf5268007658df88133553f5e4e75523f"
    },
    "modified_at": "2026-08-04T03:06:14+00:00"
}