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CPT 99497: Advance Care Planning, First 30 Minutes
CPT code 99497 covers the first 30 minutes of face-to-face advance care planning—structured conversations in which a clinician discusses future health care preferences with a patient and their family or representative. Nationally, this code formalizes reimbursement for time spent on goals-of-care and advance directive discussions, supporting patient-centered decision making and care planning across ambulatory and clinic settings.
Key payers examined include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, common associated diagnoses, related CPT guidance, and payer coverage considerations. The publication highlights where CPT code 99497 fits into clinical workflows, typical sites of service, and linkage to follow-on billing (such as additional 30-minute increments captured by CPT code 99498).
This summary equips clinicians, billing staff, and policy analysts with the essential facts about CPT code 99497, including service definition, typical use cases, and the major national payers that commonly cover the service. Data not available in the input is noted where applicable.
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Billing Code Overview
CPT code 99497 describes advance care planning where the provider discusses and shares planning with a patient, their family, or a designated representative regarding the patient’s future health care needs. The code is used for the first 30 minutes of face-to-face time that the provider spends on this discussion.
Service type: Advance care planning / goals-of-care discussion
Typical site of service: Office or other face-to-face clinical setting
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.