Billing code 99497: Advance care planningMedicare rate & RVUs in Ohio
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.
Medicare pays $83.93 for 99497 in the office in Ohio (Ohio). 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 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 billing code 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.
99497 in Ohio
| Payment locality | Office | Facility |
|---|---|---|
| Ohio | $83.93 | $64.72 |
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.
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.
99497 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 99498Advance care planning
- 99497 covers the first 30-minute unit, starting at 16 minutes. 99498 is the add-on for further 30-minute units, first reported once total ACP time reaches 46 minutes.
- 99483Cognitive care plan
- 99483 assesses cognitive impairment and develops a care plan that may address advance care preferences. Use 99497 for a separately performed, timed ACP discussion; do not count the same work twice.
- 99214Office visit
- 99214 covers an established patient's problem-oriented office visit. Report 99497 for a separately documented, qualifying discussion of advance directives and future care preferences, without counting ACP time toward a time-selected office visit.
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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