# CPT 99497: Advance Care Planning First 30 Mins

Medicare CPT 99497 pays $86.84 in a non-facility setting and $65.80 in a facility setting under the 2026 Medicare Physician Fee Schedule, before geographic adjustment. After geographic adjustment, state amounts run from $80.63 in Arkansas to $112.74 in Alaska, a 40% spread.

Web page: https://www.med-reveal.com/rates/99497-cpt-fee-schedule
Section: Evaluation and Management
Billed by: Evaluation, Hematology & Oncology, Internal Medicine

## Medicare rates

| | Amount |
| --- | --- |
| National non-facility | $86.84 |
| National facility | $65.80 |
| Conversion factor | 33.4009 |
| Release | 2026 Q4 (effective 2026-10-01) |

## By state

| State | Non-facility | Facility |
| --- | --- | --- |
| Alaska | $112.74 | $90.33 |
| District of Columbia | $95.89 | $71.10 |
| New York | $94.20 | $70.72 |
| New Jersey | $93.92 | $70.22 |
| California | $93.44 | $68.55 |
| Washington | $92.51 | $68.53 |
| Massachusetts | $91.97 | $68.32 |
| Connecticut | $91.07 | $68.41 |
| Hawaii | $90.20 | $66.27 |
| Florida | $89.80 | $68.69 |
| Maryland | $89.16 | $67.22 |
| Colorado | $88.94 | $66.55 |
| Illinois | $88.62 | $68.29 |
| Rhode Island | $88.58 | $66.85 |
| Oregon | $88.22 | $66.05 |
| New Hampshire | $87.85 | $65.94 |
| Puerto Rico | $87.17 | $65.89 |
| Virgin Islands | $87.17 | $65.89 |
| Montana | $86.84 | $65.79 |
| Pennsylvania | $86.81 | $66.19 |
| Delaware | $86.38 | $65.59 |
| Texas | $86.38 | $65.66 |
| Nevada | $86.37 | $65.31 |
| Wyoming | $86.06 | $65.02 |
| Michigan | $86.01 | $66.25 |
| Georgia | $85.96 | $65.89 |
| Minnesota | $85.70 | $64.05 |
| Virginia | $85.39 | $64.70 |
| Arizona | $85.36 | $64.97 |
| North Dakota | $85.06 | $64.01 |
| Vermont | $85.02 | $64.19 |
| South Dakota | $84.85 | $63.80 |
| New Mexico | $84.65 | $65.35 |
| Utah | $84.51 | $64.73 |
| Maine | $84.22 | $64.11 |
| Louisiana | $84.05 | $64.83 |
| Missouri | $84.02 | $64.71 |
| Ohio | $83.93 | $64.72 |
| South Carolina | $83.83 | $64.38 |
| West Virginia | $83.72 | $65.43 |
| North Carolina | $83.50 | $63.86 |
| Wisconsin | $83.35 | $63.19 |
| Kentucky | $82.84 | $64.14 |
| Indiana | $82.83 | $63.33 |
| Idaho | $82.56 | $63.20 |
| Oklahoma | $82.56 | $63.77 |
| Tennessee | $82.38 | $63.25 |
| Nebraska | $82.37 | $62.95 |
| Iowa | $82.16 | $62.91 |
| Kansas | $82.11 | $63.09 |
| Mississippi | $81.37 | $63.25 |
| Alabama | $81.32 | $62.91 |
| Arkansas | $80.63 | $62.55 |

## Related codes

- 99201: New Patient Office Visit: Coverage and Documentation Requirements — https://www.med-reveal.com/rates/99201-cpt-fee-schedule
- 99241: Office consultation for a new or established patient that requires these three key components: a problem-focused history; a problem-focused examination; and straightforward medical decision-making — https://www.med-reveal.com/rates/99241-cpt-fee-schedule
- 99251: Inpatient consultation for a new or established patient which requires these 3 key components: A problem focused history; A problem focused examination; and Straightforward medical decision making. — https://www.med-reveal.com/rates/99251-cpt-fee-schedule
- 99288: Phys/qhp Direction Emergency Medical Systems — https://www.med-reveal.com/rates/99288-cpt-fee-schedule
- 99354: Prolonged Service With Direct Patient Contact — https://www.med-reveal.com/rates/99354-cpt-fee-schedule
- 99355: Prolonged Service With Direct Patient Contact — https://www.med-reveal.com/rates/99355-cpt-fee-schedule
- 99358: Prolng E/m Svc Before&/after Dir Pt Care 1st Hr — https://www.med-reveal.com/rates/99358-cpt-fee-schedule
- 99359: Prolng E/m Before&/after Dir Care Ea 30 Minutes — https://www.med-reveal.com/rates/99359-cpt-fee-schedule

Commercial negotiated rates for 99497 by payer and state: https://www.med-reveal.com/solutions/rate-benchmarking

## Sources

- CMS Medicare fee schedules (2026 Q4): https://www.cms.gov/medicare/payment/fee-schedules