CPT 99497: Advance Care Planning, First 30 Minutes
Medicare pays $89 and commercial payers pay $105 on average nationally for this procedure.
CPT code 99497 describes advance care planning involving discussion and documentation of future health care preferences with the patient, family, or a patient representative; this code is used for the first 30 minutes of face-to-face advance care planning provided by a clinician. The service type is advance care planning / counseling, and the typical site of service is office or other face-to-face clinical setting where the provider meets with the patient and/or family to discuss goals of care and advance directives.
For related coverage guidance, see recent payer policy updates: Percutaneous Electrical Nerve Field Stimulation for Functional Abdominal Pain Disorders, Esophagogastroduodenoscopy (EGD) Coverage Policy, Radiofrequency Therapy for Fecal Incontinence.
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National Reimbursement Benchmarks
Commercial means sit above Medicare: Blue Cross Blue Shield, Cigna, UnitedHealth Group, Aetna, and BUCA all report mean rates higher than Medicare’s mean of $89.3. BUCA’s mean of $105.3 is roughly $16.0 above Medicare, while UnitedHealth Group ($127.0) and Cigna ($123.4) show substantially higher commercial averages that widen the gap with Medicare’s $89.3.
Dispersion (P75–P25) highlights where commercial pricing is most and least variable. UnitedHealth Group’s interquartile spread is $71.5 and Cigna’s is $69.7, making them the widest among listed payers. Blue Cross Blue Shield and BUCA have intermediate spreads of $33.2 and $47.6, respectively. Aetna’s spread is $37.5, the tightest among payers with full quartile data, indicating relatively constrained commercial variation compared with UnitedHealth Group and Cigna.