Find policies, billing codes, payers, states, and providers
CPT 99498: Advanced Care Planning, Each Additional 30 Minutes
CPT code 99498 covers additional face-to-face time for advance care planning beyond the initial 30 minutes. It is an add-on time-based code used when a provider continues or expands discussions about future health care decisions, including the completion or review of advance directives. The code supports documentation of prolonged, structured conversations that can inform end-of-life care preferences and care coordination.
Key national payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare. Discussion of payer coverage highlights whether extended advance care planning encounters are recognized and reimbursed as add-on time, which affects clinician workflow and coding choices nationally.
Readers will learn: the clinical context and intended use of 99498, how it relates to the initial advance care planning code 99497, typical service settings where extended discussions occur, and the common payer landscape that determines recognition of additional 30-minute increments. The summary provides a concise reference for billing teams, clinical leaders, and policy analysts seeking to understand where 99498 fits within ambulatory counseling services and time-based advance care planning documentation.
Customize your policy alerts
Sign up for cpt 99498 policy alerts
Get alerted when payer policies referencing 99498 are released or updated.
Monitor payer policy activity
Billing Code Overview
CPT code 99498 describes advanced care planning beyond an initial 30 minutes. The provider or other healthcare professional conducts extended, face-to-face discussions about future health care preferences, including advance directives, for each additional 30 minutes of patient-facing time.
Service type: Advanced care planning (extended, face-to-face counseling)
Typical site of service: Outpatient clinic or office setting; other ambulatory care venues where face-to-face counseling occurs
National Reimbursement Benchmarks
Medicare’s national mean of $80.4 sits below BUCA’s average commercial mean of $95.7, indicating that commercial contracting through BUCA generally pays more than the Medicare baseline for CPT 99498. This gap of $15.3 highlights a modest commercial premium versus Medicare, with Medicare showing a very tight central tendency (P25 $77 to P75 $82) that suggests limited variation across localities.
Dispersion measured by the IQR (P75 minus P25) is widest for UnitedHealth Group (IQR $63.3) and Cigna (IQR $59.5), signaling broader negotiated outcomes, while Blue Cross Blue Shield (IQR $34.6) and Aetna (IQR $36.4) exhibit tighter central ranges. BUCA’s IQR is $46.7 and Medicare’s IQR is just $5, making Medicare the tightest and UnitedHealth Group the most dispersed among these payers.