CPT code 99498: Advance care planning, each additional 30 minutes2026 Medicare rate & RVUs

Medicare pays $78.16 for 99498 nationally in the office and $63.46 in a hospital or facility. Local office rates run $72.70–$102.03.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 99498 covers

This add-on represents additional face-to-face time spent discussing a patient's goals, values, and preferences for future medical care, including choices about life-sustaining treatment and advance directives. Physicians and other qualified health care professionals may furnish the discussion with the patient and, when appropriate, family members or a surrogate. These conversations commonly occur in an office or facility when a patient is considering or documenting preferences for care if they cannot make decisions later.

Report 99498 with 99497 when the documented advance care planning discussion extends beyond the initial service and supports another 30-minute unit. The record should identify the participants, topics discussed, and time spent in the face-to-face discussion. This is an add-on code: CMS requires it to be billed with a primary procedure, and payment falls within that procedure's global period. Do not use it for time spent on routine counseling or other care-management activities rather than advance care planning.

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.

Where 99498 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

99498 rates by state

Office rate range in each state. Select a state to see its payment localities.

How the 99498 rate is calculated

Each of 99498’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.

Payment rules and modifiers for 99498

The CMS indicators that decide how 99498 is paid alongside other services.

99498 compared with similar codes

How to choose

99497Advance care planningFirst 30 minutes

99497 reports the initial advance care planning service; 99498 reports each additional 30-minute unit and is not reported alone.

99483Cognitive care planComprehensive assessment

99483 covers assessment and care planning for a patient with cognitive impairment. 99498 reports additional time specifically spent on advance care planning.

99489Complex chronic care managementEach additional 30 minutes

99489 reports additional time for complex chronic care management. 99498 is for additional advance care planning discussion, not ongoing care coordination.

Codes related to 99498

Related codes aren’t interchangeable: bill the code that matches the service performed.

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

Open CMS sourceHow we calculate rates