Reimbursement
$86.84
Threshold
30m
2026 Status
Active
What is CPT Code 99497?
CPT 99497 is defined as: Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; first 30 minutes, face-to-face with the patient, family member(s), and/or surrogate.
This code is primarily used for Preventive services. It falls under the category of Evaluation & Management and is valid for the 2026 calendar year according to the CMS Physician Fee Schedule.
2026 RVU Components
Relative Value Units (Non-Facility)
Work RVU
1.5
Physician Effort
PE (Non-Fac)
1
Practice Expense
Malpractice
0.1
Risk Factor
Total RVU
2.6
Note: [(Work RVU * Work GPCI) + (PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * Conversion Factor
2026 CMS Policy Intelligence
efficiency shield
Protected from the -2.5% productivity adjustment (E/M service).
preventive priority
High strategic value when bundled with AWV, resulting in zero cost to the patient while increasing practice revenue.
Administrative Framework
Place of Service
Key Modifiers
Operational Requirements
Standard CMS E/M requirements apply.
Compliance Checklist
Audit Defense
time documentation
Notes must explicitly state 'spent 30 minutes in face-to-face ACP discussion'.
voluntary statement
Documentation should mention that the patient was informed that the service is voluntary.
Common Clinical Scenarios
No clinical examples provided.
Target Specialties & Utilization
Typical Clinical Indications (ICD-10)
Frequently Asked Questions
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