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99497 CPT Code: Advance Care Planning Billing Guide

Last Updated: June 1, 2026

Advance Care Planning (ACP) is a face-to-face service where a physician and a patient discuss advance directives (such as living wills or medical powers of attorney). It is billed using CPT 99497.

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2026 Medicare National Fee (99497): Non-Facility (Office): $103.70 · Facility (Hospital): $74.03
✓ 111 Medicare-Approved ICD-10 Diagnoses on file for 99497:

Time-Based Billing for 99497

ACP is strictly a time-based code. 99497 ↗ represents the first 30 minutes of face-to-face conversation. To bill it, you must cross the midpoint, meaning the conversation must last at least 16 minutes.

CodeDescriptionTime Required
99497Advance care planning; first 30 mins16 - 45 minutes
99498Add-on for each additional 30 mins46+ minutes

Waiving the Copay (Modifier 33)

Normally, ACP is subject to the Medicare Part B deductible and coinsurance. However, if 99497 is performed on the exact same day as an Annual Wellness Visit (G0438 or G0439), append Modifier 33 to the 99497 code. This waives the patient's copay entirely.

NCCI Edits

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Not sure if these codes bundle? Check the latest Medicare NCCI database updates before you bill.

If billed outside of an AWV (e.g., during a standard sick visit like 99214), you must ensure Modifier 25 is applied to the E/M code. Check NCCI edits to ensure proper unbundling.

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