CPT 99498E&M

Advncd care plan addl 30 min

CPT 99498 covers additional time spent beyond the first 30 minutes discussing advance care planning with patients about their future healthcare decisions, end-of-life preferences, and appointing healthcare proxies.

Showing rates for

National Average

Base Medicare rate

$68.90

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

1.4

PE RVU (NF)

0.63

MP RVU

0.1

Total RVU

2.13

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

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Billing tips

Document exact start and stop times for the additional 30-minute increment(s) to justify each unit of 99498
Impact: Critical for audit defense; lack of time documentation is the #1 reason for denials, potentially costing $68.90 per rejected unit
Bill 99498 only after first reporting 99497; this is an add-on code that cannot be billed independently
Impact: Prevents automatic denial; 100% claim rejection if billed without base code 99497
Count only face-to-face counseling time with patient/surrogate; preparation and documentation time do not count toward the threshold
Impact: Overcounting time can trigger recoupment during audits; only direct counseling minutes qualify for the $68.90 payment
Medicare removed frequency limitations in 2016; bill 99497/99498 as often as medically necessary with appropriate documentation
Impact: Allows multiple billing opportunities per year for patients with changing conditions, increasing revenue potential by $137.80+ per extended session
These codes can be billed on the same day as other E/M services without modifier 25 since they are not E/M codes
Impact: Captures additional $68.90 per 30-minute increment without risking bundling denials when billed with office visits
Report multiple units of 99498 for extended sessions: one unit for 46-75 minutes total, two units for 76-105 minutes, etc.
Impact: Each additional unit adds $68.90 to reimbursement; proper unit reporting can capture $137.80-$206.70 for extended discussions

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Frequently asked questions

How much does Medicare pay for CPT code 99498 in 2025?

Medicare pays $68.90 for CPT 99498 in non-facility settings and $68.57 in facility settings based on the 2025 national average rates. The code carries 2.13 total RVUs (1.4 work RVU, 0.63 non-facility PE RVU, 0.1 malpractice RVU).

Can CPT 99498 be billed alone or does it require another code?

CPT 99498 is an add-on code and cannot be billed alone. It must always be reported with the primary advance care planning code 99497, which covers the first 30 minutes. Code 99498 represents each additional 30-minute increment beyond the first 30 minutes.

How many times can I bill CPT 99498 in one session?

You can bill multiple units of 99498 based on total time documented: one unit for 46-75 total minutes, two units for 76-105 minutes, three units for 106-135 minutes, etc. Each unit represents an additional 30-minute increment beyond the base 99497.

What is the minimum time required to bill CPT 99498?

You need a total of at least 46 minutes of face-to-face advance care planning time to bill one unit of 99498 (30 minutes for base code 99497 plus at least 16 additional minutes). The additional increment must reach the midpoint of the 30-minute interval to qualify.

Can CPT 99498 be billed with an office visit on the same day?

Yes, CPT 99497/99498 can be billed on the same day as evaluation and management services without modifier 25. These are not traditional E/M codes and CMS specifically allows same-day billing when both services are medically reasonable and separately documented.

Is there a limit to how often CPT 99498 can be billed per patient?

No, Medicare removed frequency limitations for advance care planning codes (99497/99498) in 2016. These codes can be billed as often as medically necessary when a patient's condition changes or they wish to update their advance directives, with proper documentation.

What RVU value does CPT 99498 have for MIPS reporting?

CPT 99498 has a total RVU value of 2.13 for 2025, consisting of 1.4 work RVUs, 0.63 practice expense RVUs (non-facility), and 0.1 malpractice RVUs. These RVUs contribute to MIPS calculations and physician productivity metrics.