{
    "code": "99497",
    "coding_system": "CPT",
    "canonical_url": "https://localishealth.com/cpt/99497/2016/A",
    "release_specific_url": "https://localishealth.com/cpt/99497/2016/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": "How much did Medicare pay for CPT 99497 in Q4 2016?",
        "text": "Medicare paid $85.93 for CPT 99497 in the office (non-facility) setting and $79.49 in a facility under the Q4 2016 Physician Fee Schedule, effective October 2016. These are the national allowed amounts before the ~2% sequestration cut and before locality (GPCI) adjustment."
    },
    "release": {
        "schedule": "pfs",
        "year": 2016,
        "quarter": "D",
        "label": "Q4 2016",
        "effective": "October 1 – December 31, 2016",
        "revision": 1
    },
    "status": {
        "code": "A",
        "non_facility_payable": true,
        "facility_payable": true
    },
    "national_rates_usd": {
        "office_non_facility": 85.93,
        "facility": 79.49,
        "sequestration_applied": false,
        "gpci": 1
    },
    "rvus": {
        "work": 1.5,
        "practice_expense_non_facility": 0.8,
        "practice_expense_facility": 0.62,
        "malpractice": 0.1
    },
    "formula": "(work_rvu × work_gpci + pe_rvu × pe_gpci + mp_rvu × mp_gpci) × conversion_factor",
    "conversion_factor": 35.8043,
    "source": {
        "label": "Physician relative value file (Q4 2016)",
        "cms_url": "https://www.cms.gov/medicare/medicare-fee-for-service-payment/physicianfeesched/downloads/rvu16d.zip",
        "local_source_url": "https://localishealth.com/sources/physician-fee-schedule/2016/D",
        "file": "PPRRVU16_V0804.csv",
        "row": 16313,
        "sha256": "376b12d2df1b1c1abaed1e123e9501352bf559c75a0a4f87f52878742af491c9"
    },
    "modified_at": "2026-08-04T03:07:13+00:00"
}