CPT Code 99497: Advance Care Planning, First 30 Minutes

CPT code 99497 reports the first 30 minutes of face-to-face advance care planning with a patient, family member, or authorized surrogate. The service includes discussing the patient’s goals, values, treatment preferences, advance directives, healthcare proxy decisions, and future care options. Completing legal forms is not required, but the medical record must document the topics discussed, who participated, the patient’s consent, and the total counseling time.

When the session extends beyond the initial time threshold, CPT code 99498 may be reported for each additional 30 minutes when supported by documentation.

To bill CPT code 99497 correctly, document a voluntary advance care planning discussion that meets the required time threshold and includes the patient, authorized surrogate, or family member when appropriate. The note should identify the participants, summarize the care goals and treatment preferences discussed, record the total time spent, and confirm that the patient agreed to the service.

Medicare may waive the deductible and coinsurance when advance care planning is provided during an eligible Annual Wellness Visit and reported under the applicable billing rules. Incomplete time documentation, missing consent, or failure to distinguish the counseling from another same-day service can lead to denied CPT 99497 claims.

CPT code 99497 claims are often denied when the record does not include the total advance care planning time, patient consent, participants in the discussion, or the specific care preferences reviewed. Practices may also lose reimbursement by reporting 99497 for a brief conversation that does not meet the required time threshold or by billing CPT code 99498 without enough additional documented time. A complete note should clearly separate advance care planning from other same-day services and show that the discussion addressed future treatment choices, advance directives, goals of care, or surrogate decision-making.