Billing code 99498: Advance care planningMedicare rate & RVUs in Florida
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.
Medicare pays $78.42–$83.92 for 99498 in the office in Florida, from Rest Of Florida to Miami. Which amount applies depends on the service address.
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 9 sections
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 in Florida
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
3 payment localities
$78.42 to $83.92
| Payment locality | Office | Facility |
|---|---|---|
| Fort Lauderdale | $80.96 | $66.07 |
| Miami | $83.92 | $68.62 |
| Rest Of Florida | $78.42 | $64.37 |
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
Swap in your local Medicare rate.
Work 1.40Practice expense 0.85Malpractice 0.09
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
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
| Rule | CMS value | What it means |
|---|---|---|
| Global period | ZZZ | Add-on code: falls within the primary procedure’s global period. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
99498 compared with similar codes
Compare codes
99498 vs 99497 vs 99483 vs 99489: national Medicare rates
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How to choose
- 99497Advance care planning
- 99497 reports the initial advance care planning service; 99498 reports each additional 30-minute unit and is not reported alone.
- 99483Cognitive care plan
- 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 management
- 99489 reports additional time for complex chronic care management. 99498 is for additional advance care planning discussion, not ongoing care coordination.
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
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