How much does Medicare pay for CPT 99497?

Medicare allowed an average of $73.95 per service and paid $61.75 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $185.22, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 99497?

Advance care planning, first 30 minutes. It was billed 2,539,170 times to 2,219,963 Medicare beneficiaries by 29,529 providers in 2024.

Does 99497 pay differently in an office than a hospital?

Yes. The allowed amount averaged $75.82 in an office setting and $70.85 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 99497 most?

Internal Medicine, with 890,530 services from 8,781 clinicians. Next are Nurse Practitioner, Family Practice, Hospitalist.

CPT 99497

Advance care planning, first 30 minutes

$73.95Medicare-allowed amount per service, averaged across 2,539,170 services

Providers submitted

$185.22

Asking price, not received

Medicare allowed

$73.95

The fee schedule figure

Medicare paid

$61.75

Balance is patient coinsurance

Providers submitted an average of $185.22 for this code and Medicare allowed $73.95 — 2.5× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $61.75 (84%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $75.82
Hospital / facility: $70.85

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 1,581,052 services were billed in an office setting and 958,118 in a facility.

Services: 2,539,170
Beneficiaries: 2,219,963
Providers billing it: 29,529
Total allowed: $187,771,622

What Medicare pays for CPT 99497

Across 2,539,170 services billed by 29,529 providers to 2,219,963 beneficiaries, Medicare allowed an average of $73.95 per service. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 99497

Specialty	Services	Beneficiaries	Avg allowed	Providers
Internal Medicine	890,530	814,315	$77.92	8,781
Nurse Practitioner	693,851	542,957	$65.50	9,501
Family Practice	547,416	513,659	$77.14	5,786
Hospitalist	90,141	82,735	$75.47	1,600
Physician Assistant	79,293	69,976	$65.21	1,420
Hospice and Palliative Care	54,143	41,463	$76.28	749
General Practice	40,806	31,999	$80.46	227
Geriatric Medicine	23,132	19,922	$78.22	291
Emergency Medicine	18,593	15,326	$79.37	176
Physical Medicine and Rehabilitation	15,378	13,165	$72.73	84
Neurology	12,152	11,467	$86.49	62
Cardiology	11,799	9,790	$81.82	77
Pulmonary Disease	9,178	7,901	$80.74	90
Nephrology	8,494	6,128	$79.08	132
Hematology-Oncology	6,171	5,428	$80.04	139

99497 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
California	366,046	$79.43	$62.51	2,863
Florida	285,456	$74.99	$64.18	2,705
New York	210,078	$82.41	$60.64	2,207
Texas	202,141	$73.35	$61.95	2,489
New Jersey	98,637	$74.51	$62.96	1,174
Illinois	93,303	$75.97	$60.89	1,119
Maryland	84,071	$78.04	$61.51	947
Georgia	80,790	$73.54	$64.79	999
Arizona	79,795	$71.91	$61.97	870
North Carolina	73,923	$69.85	$60.48	1,189
Pennsylvania	69,559	$72.05	$60.41	1,023
South Carolina	68,388	$69.08	$59.22	750
Michigan	65,422	$69.08	$64.09	1,018
Nevada	60,160	$70.61	$57.53	420
Ohio	58,072	$66.29	$61.17	840
Virginia	58,038	$74.40	$63.01	761
Tennessee	56,315	$65.49	$62.42	801
Massachusetts	46,426	$74.34	$60.67	691
Washington	39,029	$74.47	$60.86	611
Indiana	37,313	$68.66	$59.76	491
Alabama	32,981	$70.34	$66.17	435
Colorado	32,652	$65.63	$59.73	440
Mississippi	29,399	$71.30	$69.67	316
Kentucky	28,367	$70.02	$61.22	342
Louisiana	26,223	$69.93	$61.31	365
Oklahoma	24,009	$68.83	$65.30	304
Missouri	23,081	$67.52	$58.06	300
Connecticut	22,005	$75.48	$59.18	370
Arkansas	20,078	$62.23	$66.47	277
Utah	18,750	$69.89	$60.01	205
Hawaii	13,012	$75.27	$61.63	136
Wisconsin	13,005	$68.10	$58.35	244
Nebraska	12,781	$52.53	$58.81	159
Kansas	12,313	$65.14	$60.46	200
Delaware	11,800	$65.05	$65.95	115
West Virginia	10,815	$71.44	$60.12	115
Oregon	10,168	$70.79	$62.31	204
Minnesota	8,589	$68.64	$54.95	191
District of Columbia	8,255	$82.72	$63.68	99
Idaho	7,601	$68.15	$56.61	101
New Mexico	7,186	$71.78	$61.07	114
Rhode Island	6,691	$74.57	$58.89	112
Iowa	6,125	$66.08	$57.86	107
New Hampshire	5,664	$68.95	$53.79	74
Montana	4,497	$62.88	$64.53	59
Maine	3,070	$71.28	$56.87	57
South Dakota	2,422	$66.47	$54.03	34
Wyoming	1,122	$67.92	$52.18	19
Alaska	1,078	$89.02	$52.79	22
North Dakota	820	$70.38	$55.28	17
Vermont	598	$70.83	$53.85	15
Puerto Rico	360	$76.85	$58.16	5
XX	243	$79.02	$54.97	1
U.S. Virgin Islands	127	$78.15	$45.86	2
Guam	117	$78.05	$76.17	1
AP	106	$63.89	$45.68	1

Related codes

99490Chronic care management services$59.70
99439Chronic care management services for two or more chronic conditions$46.13
99457Management using the results of remote vital sign monitoring per calen$48.61
99458Management using the results of remote vital sign monitoring per calen$39.11
99454Remote monitoring of physiologic parameters$47.97
99489Complex chronic care management services for two or more chronic condi$67.00
99442Telephone medical discussion$83.84
99443Telephone medical discussion$120.39
99487Complex chronic care management services for two or more chronic condi$124.70
99496Transitional care management services for problem of high complexity$252.87
99426Principal care management services for a single high-risk disease$60.08
99484Care management services for behavioral health conditions$50.05

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.