CPT code 99497: Advance care planning, first 30 minutes2026 Medicare rate & RVUs in New Mexico
Face-to-face discussion of advance directives and future care wishes with a patient, family member, or surrogate, reported for the first 30 minutes of advance care planning.
In New Mexico, Medicare pays $84.65 for 99497 in the office and $65.35 when it’s performed in a hospital or facility.
Check a contract rate as a % of Medicare · 99497 nationwide
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 11 sections
What 99497 covers
This service covers a face-to-face conversation in which a physician or qualified nonphysician practitioner explains advance directives and helps the patient, family, or surrogate consider goals of care, preferred treatments, and who should make decisions if the patient cannot. Completing a health care proxy or living will is included when it happens, but a completed form is not required. Primary care, geriatrics, oncology, palliative care, nephrology, and hospitalist clinicians furnish it in offices, hospitals, nursing facilities, and patient homes.
The code is time-based. Under the CPT midpoint rule, at least 16 minutes of advance care planning time must be documented. At 46 minutes, add 99498 for the first additional 30-minute unit; another unit begins at 76 minutes. Documentation should show voluntary participation, who was present, what was discussed, any forms completed, and ACP time separate from other services. Medicare sets no frequency limit, but repeated discussions should document changes in health status or wishes. When ACP is furnished with an Annual Wellness Visit, report the applicable ACP code or codes with modifier 33 for waived Medicare deductible and coinsurance.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Billing guides for 99497: Annual wellness visit codes
How New Mexico compares for 99497
Across 109 of 109 payment localities, the office rate for 99497 runs from $80.63 in Arkansas to $112.74 in Alaska. New Mexico pays $84.65. The RVUs are the same everywhere; the geographic indexes change the dollars.
- New Mexico · this page$84.65
- Los Angeles, CA · California$94.06+$9.41
- Washington, DC area · District of Columbia$95.89+$11.24
- Miami, FL · Florida$92.82+$8.17
- Chicago, IL · Illinois$91.25+$6.60
- Manhattan, NY · New York$97.28+$12.63
- Alaska · Alaska$112.74+$28.09
Other areas in New Mexico first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | $81.32 | $62.91 |
| ArkansasArkansas | $80.63 | $62.55 |
| ArizonaArizona | $85.36 | $64.97 |
| Bakersfield, CACalifornia | $89.86 | $66.79 |
| Chico, CACalifornia | $89.54 | $66.48 |
| El Centro, CACalifornia | $89.55 | $66.49 |
| Fresno, CACalifornia | $89.54 | $66.48 |
| Hanford, CACalifornia | $89.54 | $66.48 |
| Madera, CACalifornia | $89.54 | $66.48 |
| Merced, CACalifornia | $89.54 | $66.48 |
| Modesto, CACalifornia | $89.54 | $66.48 |
| Napa, CACalifornia | $99.25 | $71.51 |
| Oxnard, CACalifornia | $93.25 | $68.38 |
| Redding, CACalifornia | $89.54 | $66.48 |
| Rest of CaliforniaCalifornia | $89.54 | $66.48 |
| Riverside, CACalifornia | $90.54 | $67.48 |
| Sacramento, CACalifornia | $92.75 | $68.28 |
| Salinas, CACalifornia | $92.36 | $67.98 |
| San Diego, CACalifornia | $93.58 | $68.41 |
| Marin County, CACalifornia | $103.81 | $74.14 |
| San Francisco, CACalifornia | $103.70 | $74.03 |
| San Benito County, CACalifornia | $105.87 | $75.53 |
| Santa Clara County, CACalifornia | $105.45 | $75.11 |
| San Luis Obispo, CACalifornia | $90.99 | $67.02 |
| Santa Cruz, CACalifornia | $93.75 | $68.19 |
| Santa Maria, CACalifornia | $92.45 | $67.91 |
| Santa Rosa, CACalifornia | $94.64 | $68.80 |
| Stockton, CACalifornia | $89.54 | $66.48 |
| Vallejo, CACalifornia | $99.10 | $71.37 |
| Visalia, CACalifornia | $89.54 | $66.48 |
| Yuba City, CACalifornia | $89.54 | $66.48 |
| ColoradoColorado | $88.94 | $66.55 |
| ConnecticutConnecticut | $91.07 | $68.41 |
| DelawareDelaware | $86.38 | $65.59 |
| Fort Lauderdale, FLFlorida | $89.71 | $68.39 |
| Rest of FloridaFlorida | $86.87 | $66.75 |
| Atlanta, GAGeorgia | $88.14 | $66.76 |
| Rest of GeorgiaGeorgia | $83.78 | $65.01 |
| Hawaii, Guam, HIHawaii | $90.20 | $66.27 |
| IowaIowa | $82.16 | $62.91 |
| IdahoIdaho | $82.56 | $63.20 |
| East St. Louis, ILIllinois | $87.19 | $67.83 |
| Rest of IllinoisIllinois | $85.60 | $66.39 |
| Suburban Chicago, ILIllinois | $90.42 | $68.81 |
| IndianaIndiana | $82.83 | $63.33 |
| KansasKansas | $82.11 | $63.09 |
| KentuckyKentucky | $82.84 | $64.14 |
| New Orleans, LALouisiana | $85.26 | $65.46 |
| Rest of LouisianaLouisiana | $82.84 | $64.21 |
| Metropolitan Boston, MAMassachusetts | $95.11 | $69.99 |
| Rest of MassachusettsMassachusetts | $88.82 | $66.66 |
| Baltimore area, MDMaryland | $90.82 | $68.24 |
| Rest of MarylandMaryland | $87.50 | $66.21 |
| Rest of MaineMaine | $83.01 | $63.65 |
| Southern Maine, MEMaine | $85.43 | $64.58 |
| Detroit, MIMichigan | $87.72 | $67.42 |
| Rest of MichiganMichigan | $84.30 | $65.08 |
| MinnesotaMinnesota | $85.70 | $64.05 |
| Metropolitan Kansas City, MOMissouri | $84.72 | $64.96 |
| Metropolitan St. Louis, MOMissouri | $85.23 | $65.20 |
| Rest of MissouriMissouri | $82.11 | $63.97 |
| MississippiMississippi | $81.37 | $63.25 |
| MontanaMontana | $86.84 | $65.79 |
| North CarolinaNorth Carolina | $83.50 | $63.86 |
| North DakotaNorth Dakota | $85.06 | $64.01 |
| NebraskaNebraska | $82.37 | $62.95 |
| New HampshireNew Hampshire | $87.85 | $65.94 |
| Northern New JerseyNew Jersey | $95.60 | $71.19 |
| Rest of New JerseyNew Jersey | $92.24 | $69.26 |
| NevadaNevada | $86.37 | $65.31 |
| NYC suburbs and Long Island, NYNew York | $99.00 | $73.98 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $92.93 | $69.89 |
| Queens, NYNew York | $97.52 | $72.64 |
| Rest of New YorkNew York | $84.26 | $64.27 |
| OhioOhio | $83.93 | $64.72 |
| OklahomaOklahoma | $82.56 | $63.77 |
| Portland, OROregon | $90.62 | $67.24 |
| Rest of OregonOregon | $85.81 | $64.86 |
| Metropolitan Philadelphia, PAPennsylvania | $89.71 | $67.80 |
| Rest of PennsylvaniaPennsylvania | $83.91 | $64.59 |
| Puerto RicoPuerto Rico | $87.17 | $65.89 |
| Rhode IslandRhode Island | $88.58 | $66.85 |
| South CarolinaSouth Carolina | $83.83 | $64.38 |
| South DakotaSouth Dakota | $84.85 | $63.80 |
| TennesseeTennessee | $82.38 | $63.25 |
| Austin, TXTexas | $88.56 | $66.29 |
| Beaumont, TXTexas | $83.59 | $64.44 |
| Brazoria, TXTexas | $86.28 | $65.43 |
| Dallas, TXTexas | $86.73 | $65.77 |
| Fort Worth, TXTexas | $86.43 | $65.69 |
| Galveston, TXTexas | $86.49 | $65.59 |
| Houston, TXTexas | $88.14 | $67.24 |
| Rest of TexasTexas | $84.83 | $64.86 |
| UtahUtah | $84.51 | $64.73 |
| VirginiaVirginia | $85.39 | $64.70 |
| Virgin Islands, VIUnited States Virgin Islands | $87.17 | $65.89 |
| VermontVermont | $85.02 | $64.19 |
| Rest of WashingtonWashington | $88.56 | $66.41 |
| King County, WAWashington | $96.46 | $70.64 |
| WisconsinWisconsin | $83.35 | $63.19 |
| West VirginiaWest Virginia | $83.72 | $65.43 |
| WyomingWyoming | $86.06 | $65.02 |
99497 rates by state
Office rate range in each state. Select a state to see its payment localities.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
$80.63
$112.74
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $112.74 | 1 |
| AL | $81.32 | 1 |
| AR | $80.63 | 1 |
| AZ | $85.36 | 1 |
| CA | $89.54–$105.87 | 29 |
| CO | $88.94 | 1 |
| CT | $91.07 | 1 |
| DC | $95.89 | 1 |
| DE | $86.38 | 1 |
| FL | $86.87–$92.82 | 3 |
| GA | $83.78–$88.14 | 2 |
| GU | $90.20 | 1 |
| HI | $90.20 | 1 |
| IA | $82.16 | 1 |
| ID | $82.56 | 1 |
| IL | $85.60–$91.25 | 4 |
| IN | $82.83 | 1 |
| KS | $82.11 | 1 |
| KY | $82.84 | 1 |
| LA | $82.84–$85.26 | 2 |
| MA | $88.82–$95.11 | 2 |
| MD | $87.50–$95.89 | 3 |
| ME | $83.01–$85.43 | 2 |
| MI | $84.30–$87.72 | 2 |
| MN | $85.70 | 1 |
| MO | $82.11–$85.23 | 3 |
| MS | $81.37 | 1 |
| MT | $86.84 | 1 |
| NC | $83.50 | 1 |
| ND | $85.06 | 1 |
| NE | $82.37 | 1 |
| NH | $87.85 | 1 |
| NJ | $92.24–$95.60 | 2 |
| NM | $84.65 | 1 |
| NV | $86.37 | 1 |
| NY | $84.26–$99.00 | 5 |
| OH | $83.93 | 1 |
| OK | $82.56 | 1 |
| OR | $85.81–$90.62 | 2 |
| PA | $83.91–$89.71 | 2 |
| PR | $87.17 | 1 |
| RI | $88.58 | 1 |
| SC | $83.83 | 1 |
| SD | $84.85 | 1 |
| TN | $82.38 | 1 |
| TX | $83.59–$88.56 | 8 |
| UT | $84.51 | 1 |
| VA | $85.39–$95.89 | 2 |
| VI | $87.17 | 1 |
| VT | $85.02 | 1 |
| WA | $88.56–$96.46 | 2 |
| WI | $83.35 | 1 |
| WV | $83.72 | 1 |
| WY | $86.06 | 1 |
How the 99497 rate is calculated
Each of 99497’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 99497
RVUs × geographic indexes × conversion factor
Work1.50
1.50 RVUs× 1.000 GPCI
Practice expense1.01
1.01 RVUs× 1.000 GPCI
Malpractice0.09
0.09 RVUs× 1.000 GPCI
Adjusted RVUs
2.6000
Conversion factor
$33.4009
Medicare rate
$86.84
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact New Mexico inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
13,161
- Code
- 99497
- Physician work
- 1.50
- Practice expense
- 1.01
- Malpractice
- 0.09
GPCI2026.csv
77
- Locality
- New Mexico
- Physician work
- 1.000
- Practice expense
- 0.917
- Malpractice
- 1.201
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.50 | × 1.000 | 1.5000 |
| Practice expense | 1.01 | × 0.917 | 0.9262 |
| Malpractice | 0.09 | × 1.201 | 0.1081 |
| Total RVUs | 2.5343 | ||
| Conversion factor | × 33.4009 | ||
Office rate, New Mexico$84.65
Office: (1.5 × 1 + 1.01 × 0.917 + 0.09 × 1.201) × $33.4009 = $84.65
Facility: (1.5 × 1 + 0.38 × 0.917 + 0.09 × 1.201) × $33.4009 = $65.35
Payment rules and modifiers for 99497
99497 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.
Place of service · 99497
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
$86.84
- Non-facility (office)
- $86.84
- Facility
- $65.80
Higher because the practice carries its own overhead.
How 99497 has changed in New Mexico
99497 · Office / nonfacility
$84.65
Effective 2026-10-01
The base rate is $7.08 higher than on 2025-10-01, moving from $77.57 to $84.65 (9.1%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
January 1, 2026
RVU26A
$77.57changed to$84.65
- Conversion factor 32.3465 changed to 33.4009
- Practice expense RVU 0.86 changed to 1.01
- Malpractice RVU 0.10 changed to 0.09
- Practice expense GPCI 0.908 changed to 0.917
- Malpractice GPCI 1.172 changed to 1.201
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$79.83changed to$77.57
- Conversion factor 33.2875 changed to 32.3465
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$78.52changed to$79.83
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$80.77changed to$78.52
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 0.85 changed to 0.86
- Practice expense GPCI 0.902 changed to 0.908
- Malpractice GPCI 1.169 changed to 1.172
January 1, 2023
RVU23A
$82.92changed to$80.77
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 0.87 changed to 0.85
- Practice expense GPCI 0.896 changed to 0.902
- Malpractice GPCI 1.166 changed to 1.169
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$83.30changed to$82.92
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 0.86 changed to 0.87
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$84.93changed to$83.30
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 0.82 changed to 0.86
- Malpractice RVU 0.09 changed to 0.10
- Practice expense GPCI 0.908 changed to 0.896
- Malpractice GPCI 1.207 changed to 1.166
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$85.11changed to$84.93
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 0.80 changed to 0.82
- Malpractice RVU 0.10 changed to 0.09
- Practice expense GPCI 0.921 changed to 0.908
- Malpractice GPCI 1.247 changed to 1.207
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$84.68changed to$85.11
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 0.79 changed to 0.80
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$81.49changed to$84.68
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 0.72 changed to 0.79
- Malpractice RVU 0.09 changed to 0.10
- Practice expense GPCI 0.920 changed to 0.921
- Malpractice GPCI 1.204 changed to 1.247
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$84.19changed to$81.49
- Conversion factor 35.8043 changed to 35.8887
- Practice expense RVU 0.80 changed to 0.72
- Malpractice RVU 0.10 changed to 0.09
- Practice expense GPCI 0.919 changed to 0.920
- Malpractice GPCI 1.161 changed to 1.204
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
No ratechanged to$84.19
Held through RVU16B, RVU16C, RVU16D.
January 1, 2015
RVU15A
No ratechanged toNo rate
Held through RVU15B, RVU15C, RVU15D.
January 1, 2013
RVU13AR
Earliest loaded release: No rate
Held through RVU13B, RVU13C, RVU13D, RVU14A, RVU14B, RVU14C, RVU14D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $84.65 | $65.35 | RVU26D |
| 2026-07-01 | $84.65 | $65.35 | RVU26C |
| 2026-04-01 | $84.65 | $65.35 | RVU26B |
| 2026-01-01 | $84.65 | $65.35 | RVU26A |
| 2025-10-01 | $77.57 | $71.11 | RVU25D |
| 2025-07-01 | $77.57 | $71.11 | RVU25C |
| 2025-04-01 | $77.57 | $71.11 | RVU25B |
| 2025-01-01 | $77.57 | $71.11 | RVU25A |
| 2024-10-01 | $79.83 | $73.18 | RVU24D |
| 2024-07-01 | $79.83 | $73.18 | RVU24C |
| 2024-04-01 | $79.83 | $73.18 | RVU24B |
| 2024-03-09 | $79.83 | $73.18 | RVU24AR |
| 2024-01-01 | $78.52 | $71.98 | RVU24A |
| 2023-10-01 | $80.77 | $74.05 | RVU23D |
| 2023-07-01 | $80.77 | $74.05 | RVU23C |
| 2023-04-01 | $80.77 | $74.05 | RVU23B |
| 2023-01-01 | $80.77 | $74.05 | RVU23A |
| 2022-10-01 | $82.92 | $76.10 | RVU22D |
| 2022-07-01 | $82.92 | $76.10 | RVU22C |
| 2022-04-01 | $82.92 | $76.10 | RVU22B |
| 2022-01-01 | $82.92 | $76.10 | RVU22A |
| 2021-10-01 | $83.30 | $76.73 | RVU21D |
| 2021-07-01 | $83.30 | $76.73 | RVU21C |
| 2021-04-01 | $83.30 | $76.73 | RVU21B |
| 2021-01-01 | $83.30 | $76.73 | RVU21A |
| 2020-10-01 | $84.93 | $79.03 | RVU20D |
| 2020-07-01 | $84.93 | $79.03 | RVU20C |
| 2020-04-01 | $84.93 | $79.03 | RVU20B |
| 2020-01-01 | $84.93 | $79.03 | RVU20A |
| 2019-10-01 | $85.11 | $79.46 | RVU19D |
| 2019-07-01 | $85.11 | $79.46 | RVU19C |
| 2019-04-01 | $85.11 | $79.46 | RVU19B |
| 2019-01-01 | $85.11 | $79.46 | RVU19A |
| 2018-10-01 | $84.68 | $79.71 | RVU18D |
| 2018-07-01 | $84.68 | $79.71 | RVU18C |
| 2018-04-01 | $84.68 | $79.71 | RVU18B |
| 2018-01-01 | $84.68 | $79.71 | RVU18AR1 |
| 2017-10-01 | $81.49 | $76.87 | RVU17D |
| 2017-07-01 | $81.49 | $76.87 | RVU17C |
| 2017-04-01 | $81.49 | $76.87 | RVU17B |
| 2017-01-01 | $81.49 | $76.87 | RVU17A |
| 2016-10-01 | $84.19 | $78.26 | RVU16D |
| 2016-07-01 | $84.19 | $78.26 | RVU16C |
| 2016-04-01 | $84.19 | $78.26 | RVU16B |
| 2016-01-01 | $84.19 | $78.26 | RVU16A |
| 2015-10-01 | Separate payment rules apply | Separate payment rules apply | RVU15D |
| 2015-07-01 | Separate payment rules apply | Separate payment rules apply | RVU15C |
| 2015-04-01 | Separate payment rules apply | Separate payment rules apply | RVU15B |
| 2015-01-01 | Separate payment rules apply | Separate payment rules apply | RVU15A |
| 2014-10-01 | Not in this release | Not in this release | RVU14D |
| 2014-07-01 | Not in this release | Not in this release | RVU14C |
| 2014-04-01 | Not in this release | Not in this release | RVU14B |
| 2014-01-01 | Not in this release | Not in this release | RVU14A |
| 2013-10-01 | Not in this release | Not in this release | RVU13D |
| 2013-07-01 | Not in this release | Not in this release | RVU13C |
| 2013-04-01 | Not in this release | Not in this release | RVU13B |
| 2013-01-01 | Not in this release | Not in this release | RVU13AR |
Where the New Mexico rate applies
New Mexico is a Medicare payment area, not a city. Our Census mapping connects it to 528 cities and communities in New Mexico. Some span more than one payment area; confirm with the service ZIP.
- Abeytas
- Abiquiu
- Acomita Lake
- Adelino
- Agua Fria
- Alamillo
- Alamo
- Alamogordo
99497 billing questions
What is the minimum time needed to report 99497?
At least 16 minutes of advance care planning time, since a 30-minute unit is met once its midpoint is passed. Discussions under 16 minutes are not separately reported with this code.
When is 99498 added?
Add one unit of 99498 when total advance care planning time reaches 46 minutes and another at 76 minutes, continuing in 30-minute increments. Report 99498 with 99497 on the same date.
Can 99497 be billed on the same day as an office visit?
Yes. It can be reported with an office E/M visit on the same date when the ACP discussion is separately documented. Time counted for ACP cannot also count toward a time-selected E/M visit.
How is Medicare cost sharing waived when ACP is done at a wellness visit?
Report 99497, and 99498 if applicable, with modifier 33 on the same claim and date as the Annual Wellness Visit, G0438 or G0439. Without that pairing, the usual deductible and coinsurance apply.
Does a form have to be signed to bill 99497?
No. Completing advance directive forms is included when it happens, but the documented discussion and time support billing even if the patient declines to complete a form.
Can the conversation be held with family when the patient is not present?
Yes. The discussion may take place with a family member or surrogate, including when the patient lacks decision-making capacity. Document who participated and their relationship to the patient.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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