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

Reports each additional 30 minutes of face-to-face advance care planning beyond the initial service, such as discussion of a patient's goals and future care preferences.

CMS RVU26DEffective Oct 1, 2026One payment locality91.2K Medicare services in 2024

In Wisconsin, Medicare pays $74.89 for 99498 in the office and $60.81 when it’s performed in a hospital or facility.

$74.89Office (non-facility)
$60.81Hospital or facility
−4.2%vs the national office rate ($78.16)

Check a contract rate as a % of Medicare · 99498 nationwide

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

We’ll open 99498 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Wisconsin
  2. What 99498 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

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.

How Wisconsin compares for 99498

Across 109 of 109 payment localities, the office rate for 99498 runs from $72.70 in Arkansas to $102.03 in Alaska. Wisconsin pays $74.89. The RVUs are the same everywhere; the geographic indexes change the dollars.

99498 in Wisconsin vs other payment areas
  1. Wisconsin · this page$74.89
  2. Los Angeles, CA · California$84.26+$9.37
  3. Washington, DC area · District of Columbia$86.08+$11.19
  4. Miami, FL · Florida$83.92+$9.03
  5. Chicago, IL · Illinois$82.52+$7.63
  6. Manhattan, NY · New York$87.51+$12.62
  7. Alaska · Alaska$102.03+$27.14

Other areas in Wisconsin first, then benchmark localities. Bars start at $0.

Every other payment area

99498 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$73.30$60.45
ArkansasArkansas$72.70$60.07
ArizonaArizona$76.85$62.60
Bakersfield, CACalifornia$80.60$64.49
Chico, CACalifornia$80.28$64.18
El Centro, CACalifornia$80.30$64.19
Fresno, CACalifornia$80.28$64.18
Hanford, CACalifornia$80.28$64.18

99498 rates by state

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

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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.

$72.70

$102.03

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
99498 office rate range by state
State / territoryOffice rate rangeLocalities
AK$102.031
AL$73.301
AR$72.701
AZ$76.851
CA$80.28–$94.4629
CO$79.881
CT$81.911
DC$86.081
DE$77.751
FL$78.42–$83.923
GA$75.67–$79.362
GU$80.781
HI$80.781
IA$73.931
ID$74.301
IL$77.38–$82.524
IN$74.541
KS$73.941
KY$74.751
LA$74.77–$76.892
MA$79.80–$85.252
MD$78.72–$86.083
ME$74.75–$76.792
MI$76.08–$79.232
MN$76.871
MO$74.16–$76.803
MS$73.431
MT$78.151
NC$75.171
ND$76.371
NE$74.101
NH$78.951
NJ$82.93–$85.852
NM$76.411
NV$77.681
NY$75.85–$89.095
OH$75.711
OK$74.451
OR$77.15–$81.292
PA$75.66–$80.742
PR$78.431
RI$79.661
SC$75.551
SD$76.161
TN$74.181
TX$75.39–$79.568
UT$76.151
VA$76.79–$86.082
VI$78.431
VT$76.391
WA$79.55–$86.392
WI$74.891
WV$75.731
WY$77.381

See 99498 in every payment locality

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.

How the rate is built · 99498

RVUs × geographic indexes × conversion factor

Office or facility?

Work1.40

1.40 RVUs× 1.000 GPCI

Practice expense0.85

0.85 RVUs× 1.000 GPCI

Malpractice0.09

0.09 RVUs× 1.000 GPCI

Adjusted RVUs

2.3400

Conversion factor

$33.4009

Medicare rate

$78.16

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

The exact Wisconsin inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

13,162

Code
99498
Physician work
1.40
Practice expense
0.85
Malpractice
0.09

GPCI2026.csv

111

Locality
Wisconsin
Physician work
1.000
Practice expense
0.958
Malpractice
0.308
Office calculation for 99498 in Wisconsin
ComponentRVULocality factorAdjusted
Physician work1.40× 1.0001.4000
Practice expense0.85× 0.9580.8143
Malpractice0.09× 0.3080.0277
Total RVUs2.2420
Conversion factor× 33.4009

Office rate, Wisconsin$74.89

Office: (1.4 × 1 + 0.85 × 0.958 + 0.09 × 0.308) × $33.4009 = $74.89

Facility: (1.4 × 1 + 0.41 × 0.958 + 0.09 × 0.308) × $33.4009 = $60.81

Open 99498 in the RVU calculator

Payment rules and modifiers for 99498

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

CMS payment indicators · 99498

Advance care planning, each additional 30 minutes

RuleCMS valueWhat it means
Global periodZZZAdd-on code: falls within the primary procedure’s global period.
Multiple procedures0No multiple-procedure reduction.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)0Not paid without supporting documentation.
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.

Codes related to 99498

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

Codes related to 99498
CodeHow it relatesOffice range, Wisconsin
Add-on codes
99497Advance care planning, first 30 minutesPrimary advance care planning service required with this additional-time code.$83.35
Often billed with
99213Office visit, established patient, low complexityMay accompany a separately documented office E/M service on the same date.$91.06
99214Office visit, established patient, moderate complexityMay accompany a separately documented office E/M service on the same date.$129.57

How 99498 has changed in Wisconsin

99498 · Office / nonfacility

$74.89

Effective 2026-10-01

The base rate is $9.03 higher than on 2025-10-01, moving from $65.86 to $74.89 (13.7%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

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

  1. January 1, 2026

    RVU26A

    $65.86changed to$74.89

    • Conversion factor 32.3465 changed to 33.4009
    • Practice expense RVU 0.63 changed to 0.85
    • Malpractice RVU 0.10 changed to 0.09
    • Practice expense GPCI 0.957 changed to 0.958
    • Malpractice GPCI 0.331 changed to 0.308

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $67.77changed to$65.86

    • Conversion factor 33.2875 changed to 32.3465

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $66.67changed to$67.77

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $68.47changed to$66.67

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 0.62 changed to 0.63
    • Practice expense GPCI 0.950 changed to 0.957
    • Malpractice GPCI 0.314 changed to 0.331

  5. January 1, 2023

    RVU23A

    $70.56changed to$68.47

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 0.65 changed to 0.62
    • Malpractice RVU 0.09 changed to 0.10
    • Practice expense GPCI 0.942 changed to 0.950
    • Malpractice GPCI 0.296 changed to 0.314

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $70.82changed to$70.56

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 0.64 changed to 0.65

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $72.81changed to$70.82

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 0.62 changed to 0.64
    • Practice expense GPCI 0.949 changed to 0.942
    • Malpractice GPCI 0.322 changed to 0.296

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $72.96changed to$72.81

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense GPCI 0.957 changed to 0.949
    • Malpractice GPCI 0.347 changed to 0.322

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $72.88changed to$72.96

    • Conversion factor 35.9996 changed to 36.0391

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $70.08changed to$72.88

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 0.54 changed to 0.62
    • Malpractice RVU 0.08 changed to 0.09
    • Practice expense GPCI 0.956 changed to 0.957
    • Malpractice GPCI 0.457 changed to 0.347

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $72.33changed to$70.08

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 0.59 changed to 0.54
    • Malpractice RVU 0.10 changed to 0.08
    • Practice expense GPCI 0.955 changed to 0.956
    • Malpractice GPCI 0.566 changed to 0.457

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    No ratechanged to$72.33

    Held through RVU16B, RVU16C, RVU16D.

  13. January 1, 2015

    RVU15A

    No ratechanged toNo rate

    Held through RVU15B, RVU15C, RVU15D.

  14. January 1, 2013

    RVU13AR

    Earliest loaded release: No rate

    Held through RVU13B, RVU13C, RVU13D, RVU14A, RVU14B, RVU14C, RVU14D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$74.89$60.81RVU26D
2026-07-01$74.89$60.81RVU26C
2026-04-01$74.89$60.81RVU26B
2026-01-01$74.89$60.81RVU26A
2025-10-01$65.86$65.55RVU25D
2025-07-01$65.86$65.55RVU25C
2025-04-01$65.86$65.55RVU25B
2025-01-01$65.86$65.55RVU25A
2024-10-01$67.77$67.14RVU24D
2024-07-01$67.77$67.14RVU24C
2024-04-01$67.77$67.14RVU24B
2024-03-09$67.77$67.14RVU24AR
2024-01-01$66.67$66.04RVU24A
2023-10-01$68.47$68.14RVU23D
2023-07-01$68.47$68.14RVU23C
2023-04-01$68.47$68.14RVU23B
2023-01-01$68.47$68.14RVU23A
2022-10-01$70.56$69.91RVU22D
2022-07-01$70.56$69.91RVU22C
2022-04-01$70.56$69.91RVU22B
2022-01-01$70.56$69.91RVU22A
2021-10-01$70.82$70.49RVU21D
2021-07-01$70.82$70.49RVU21C
2021-04-01$70.82$70.49RVU21B
2021-01-01$70.82$70.49RVU21A
2020-10-01$72.81$72.46RVU20D
2020-07-01$72.81$72.46RVU20C
2020-04-01$72.81$72.46RVU20B
2020-01-01$72.81$72.46RVU20A
2019-10-01$72.96$72.62RVU19D
2019-07-01$72.96$72.62RVU19C
2019-04-01$72.96$72.62RVU19B
2019-01-01$72.96$72.62RVU19A
2018-10-01$72.88$72.54RVU18D
2018-07-01$72.88$72.54RVU18C
2018-04-01$72.88$72.54RVU18B
2018-01-01$72.88$72.54RVU18AR1
2017-10-01$70.08$70.08RVU17D
2017-07-01$70.08$70.08RVU17C
2017-04-01$70.08$70.08RVU17B
2017-01-01$70.08$70.08RVU17A
2016-10-01$72.33$71.98RVU16D
2016-07-01$72.33$71.98RVU16C
2016-04-01$72.33$71.98RVU16B
2016-01-01$72.33$71.98RVU16A
2015-10-01Separate payment rules applySeparate payment rules applyRVU15D
2015-07-01Separate payment rules applySeparate payment rules applyRVU15C
2015-04-01Separate payment rules applySeparate payment rules applyRVU15B
2015-01-01Separate payment rules applySeparate payment rules applyRVU15A
2014-10-01Not in this releaseNot in this releaseRVU14D
2014-07-01Not in this releaseNot in this releaseRVU14C
2014-04-01Not in this releaseNot in this releaseRVU14B
2014-01-01Not in this releaseNot in this releaseRVU14A
2013-10-01Not in this releaseNot in this releaseRVU13D
2013-07-01Not in this releaseNot in this releaseRVU13C
2013-04-01Not in this releaseNot in this releaseRVU13B
2013-01-01Not in this releaseNot in this releaseRVU13AR

Price 99498 for an earlier date of service

Where the Wisconsin rate applies

Wisconsin is a Medicare payment area, not a city. Our Census mapping connects it to 807 cities and communities in Wisconsin. Some span more than one payment area; confirm with the service ZIP.

  • Abbotsford
  • Abrams
  • Adams
  • Adell
  • Albany
  • Algoma
  • Allens Grove
  • Allenton

Browse all communities in Wisconsin

99498 billing questions

Can 99498 be reported by itself?

No. It is an add-on and is reported with the primary advance care planning service, 99497.

When should the record support an additional unit?

Document the additional face-to-face advance care planning time, the participants, and the subjects discussed. The extra time must represent advance care planning, not unrelated counseling or care management.

Does 99498 represent the initial advance care planning discussion?

No. 99497 represents the initial service; 99498 reports each additional 30-minute unit.

Can an office E/M service be reported on the same date?

A separately identifiable E/M service may be reported for a distinct evaluation and management service on that date. Document the E/M work separately from the advance care planning discussion.

What distinguishes advance care planning from routine care management?

99498 is for additional time discussing a patient's future-care preferences, goals, or advance directives. Time coordinating ongoing chronic-condition care is not advance care planning time.

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
RVUs for 99498PPRRVU2026_Oct_nonQPP.csv, line 13,162 (RVU26D)
Geographic factors for WisconsinGPCI2026.csv, line 111 (RVU26D)

Open CMS sourceHow we calculate rates

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