CPT 99498: Advance Care Planning, Each Additional 30 Minutes
Medicare pays $80 and commercial payers pay $96 on average nationally for this procedure.
CPT code 99498 describes advanced care planning services beyond the initial 30 minutes, used when a provider spends each additional 30 minutes in face-to-face discussion and documentation of future health care preferences and advance directives; service type: advanced care planning counseling, typical site of service: office or other outpatient face-to-face clinical setting.
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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.