$88.94
99497 reports the initial advance care planning service; 99498 reports each additional 30-minute unit and is not reported alone.
On this page
CMS RVU26D · Effective 2026-10-01
99498 Advance care planning Medicare reimbursement rates in Colorado
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. Compare 99498 office and facility rates across CMS payment localities in Colorado.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 99498 in Colorado?
Colorado has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$79.88
1 of 1 localities have a supported rate.
Payment area: Colorado
One mapped payment locality.
Facility setting
$64.24
1 of 1 localities have a supported rate.
Payment area: Colorado
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Advance care planning
About 99498: Additional advance care planning time
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.
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.
CMS billing rules for 99498
- Global period
- Add-on code: billed only together with a primary procedure and paid within that procedure's global period.
Where the value comes from
- Work RVU1.40 · 60%
- Practice expense (office) RVU0.85 · 36%
- Malpractice RVU0.09 · 4%
91.2K
Medicare services in 2024 · #588 by national volume
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.
99498 compared with similar codes
Office rates for Colorado, from the same CMS release.
$302.45
99483 covers assessment and care planning for a patient with cognitive impairment. 99498 reports additional time specifically spent on advance care planning.
$80.76
99489 reports additional time for complex chronic care management. 99498 is for additional advance care planning discussion, not ongoing care coordination.
Compare 99498 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Colorado →
Office / nonfacility
$79.88
Facility
$64.24
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 99498 in Colorado.
PPRRVU2026_Oct_nonQPP.csv
13,162
- Code
- 99498
- Physician work
- 1.40
- Practice expense
- 0.85
- Malpractice
- 0.09
GPCI2026.csv
37
- Locality
- Colorado
- Physician work
- 1.012
- Practice expense
- 1.064
- Malpractice
- 0.781
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.40 | × 1.012 | 1.4168 |
| Practice expense | 0.85 | × 1.064 | 0.9044 |
| Malpractice | 0.09 | × 0.781 | 0.0703 |
| Total RVUs | 2.3915 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Colorado$79.88
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.4 | 1.012 |
| Practice expense | 0.85 | 1.064 |
| Malpractice | 0.09 | 0.781 |
(1.4 × 1.012 + 0.85 × 1.064 + 0.09 × 0.781) × $33.4009 = $79.88
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.4 | 1.012 |
| Practice expense | 0.41 | 1.064 |
| Malpractice | 0.09 | 0.781 |
(1.4 × 1.012 + 0.41 × 1.064 + 0.09 × 0.781) × $33.4009 = $64.24
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
13,15999495,,Transj care mgmt mod f2f 14d,A,,2.78,3.62,,0.69,,0.19,6.59,3.66,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,16099496,,Transj care mgmt high f2f 7d,A,,3.79,4.91,,0.95,,0.24,8.94,4.98,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,16199497,,Advncd care plan 30 min,A,,1.50,1.01,,0.38,,0.09,2.60,1.97,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,16299498,,Advncd care plan addl 30 min,A,,1.40,0.85,,0.41,,0.09,2.34,1.90,0,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,16399499,,Unlisted e&m service,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,16499500,,Home visit prenatal,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
13,16599501,,Home visit postnatal,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
3401112,CA,69,VISALIA,1.017,1.096,0.536
3501112,CA,70,YUBA CITY,1.017,1.096,0.536
3601112,CA,75,REST OF CALIFORNIA,1.017,1.096,0.536
3704112,CO,01,COLORADO,1.012,1.064,0.781
3813102,CT,00,CONNECTICUT,1.020,1.077,1.210
3912202,DC,01,DC + MD/VA SUBURBS,1.054,1.178,1.113
4012102,DE,01,DELAWARE,1.005,0.988,0.899