# CPT 99497

> Medicare paid $86.04 for CPT 99497 in the office (non-facility) setting and $80.64 in a facility under the Q4 2018 Physician Fee Schedule, effective October 2018. These are the national allowed amounts before the ~2% sequestration cut and before locality (GPCI) adjustment. This price has been unchanged since Q1 2018, when it increased 3.8%.

## What it is

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.

## Selected release

- Release: Q4 2018 (2018 D)
- Effective: October 1 – December 31, 2018
- Status indicator: A
- Office (non-facility) national allowed amount: $86.04
- Facility national allowed amount: $80.64
- Sequestration: not applied

## RVUs and formula

- Work RVU: 1.50
- Office (non-facility) practice expense RVU: 0.79
- Facility practice expense RVU: 0.64
- Malpractice RVU: 0.10
- Conversion factor: 35.9996
- Formula: `(work_rvu × work_gpci + pe_rvu × pe_gpci + mp_rvu × mp_gpci) × conversion_factor`

## Source and citation

- Source: Physician relative value file (Q4 2018)
- CMS file: https://www.cms.gov/medicare/medicare-fee-for-service-payment/physicianfeesched/downloads/rvu18d.zip
- Parsed file: PPRRVU18_OCT.csv, row 16,672
- Canonical page: https://localishealth.com/cpt/99497/2018/A
- Release-specific citation URL: https://localishealth.com/cpt/99497/2018/D
- Last significant update: 2026-08-04T03:08:37+00:00