How much does Medicare pay for CPT 99498?

Medicare allowed an average of $65.58 per service and paid $52.45 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $190.79, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 99498?

Advance care planning, each additional 30 minutes. It was billed 70,034 times to 52,912 Medicare beneficiaries by 1,429 providers in 2024.

Does 99498 pay differently in an office than a hospital?

Yes. The allowed amount averaged $64.53 in an office setting and $65.90 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 99498 most?

Nurse Practitioner, with 35,542 services from 747 clinicians. Next are Internal Medicine, Hospice and Palliative Care, Family Practice.

CPT 99498

Advance care planning, each additional 30 minutes

$65.58Medicare-allowed amount per service, averaged across 70,034 services

Providers submitted

$190.79

Asking price, not received

Medicare allowed

$65.58

The fee schedule figure

Medicare paid

$52.45

Balance is patient coinsurance

Providers submitted an average of $190.79 for this code and Medicare allowed $65.58 — 2.9× 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 $52.45 (80%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $64.53
Hospital / facility: $65.90

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 16,606 services were billed in an office setting and 53,428 in a facility.

Services: 70,034
Beneficiaries: 52,912
Providers billing it: 1,429
Total allowed: $4,592,830

What Medicare pays for CPT 99498

Across 70,034 services billed by 1,429 providers to 52,912 beneficiaries, Medicare allowed an average of $65.58 per service. That is 1.3 services per beneficiary, so this is a code patients typically receive more than once. 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 99498

Specialty	Services	Beneficiaries	Avg allowed	Providers
Nurse Practitioner	35,542	26,616	$60.32	747
Internal Medicine	11,930	8,315	$72.06	161
Hospice and Palliative Care	10,036	7,955	$71.37	249
Family Practice	5,174	4,383	$71.34	89
Physician Assistant	1,840	1,332	$58.53	54
Hospitalist	1,560	1,306	$73.87	35
Geriatric Medicine	1,090	799	$74.34	27
Emergency Medicine	593	458	$70.05	19
Anesthesiology	363	203	$74.46	4
Physical Medicine and Rehabilitation	289	238	$67.94	3
Certified Clinical Nurse Specialist	284	238	$58.68	9
Hematology-Oncology	249	221	$68.22	6
Rheumatology	232	147	$74.33	1
Critical Care (Intensivists)	182	120	$75.56	1
Pulmonary Disease	129	117	$70.37	5

99498 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
New York	8,500	$72.97	$52.11	153
California	7,842	$71.23	$53.84	120
Texas	6,512	$62.80	$49.92	107
Florida	5,992	$63.48	$50.69	80
Maryland	4,862	$64.99	$48.85	63
New Jersey	3,616	$65.70	$48.12	62
Pennsylvania	3,448	$61.56	$48.90	102
Massachusetts	2,611	$67.40	$50.72	58
North Carolina	2,456	$61.49	$50.97	69
Virginia	1,859	$64.17	$51.15	42
Hawaii	1,695	$72.58	$54.72	5
Georgia	1,457	$63.74	$52.81	31
Illinois	1,444	$64.43	$49.37	35
Arizona	1,379	$65.21	$53.21	30
Michigan	1,349	$62.60	$48.66	40
Ohio	1,212	$60.02	$48.63	46
Washington	1,070	$67.17	$51.68	29
Colorado	1,015	$62.57	$49.24	24
Indiana	929	$58.40	$48.74	27
Tennessee	861	$57.12	$47.40	28
Utah	860	$60.58	$49.19	14
Missouri	851	$60.60	$48.78	24
Wisconsin	808	$59.26	$49.23	26
South Carolina	757	$63.84	$51.93	20
Minnesota	711	$58.73	$47.50	21
Nevada	629	$58.55	$46.50	12
Louisiana	505	$64.03	$52.31	10
District of Columbia	471	$73.10	$53.10	12
Kansas	469	$64.24	$52.68	19
Kentucky	436	$62.45	$51.27	11
Connecticut	385	$67.03	$49.73	16
New Hampshire	293	$63.01	$49.24	11
New Mexico	280	$67.13	$53.64	2
Nebraska	249	$60.06	$50.02	6
Idaho	242	$61.40	$51.19	6
Rhode Island	236	$62.57	$49.03	9
Oregon	236	$64.72	$51.36	9
Iowa	233	$60.40	$49.53	6
Alabama	229	$56.69	$49.30	8
Arkansas	200	$60.06	$53.55	8
South Dakota	175	$57.55	$47.57	4
Wyoming	156	$59.40	$45.37	3
Delaware	125	$59.89	$47.60	4
Maine	113	$62.15	$49.93	3
Oklahoma	82	$68.02	$54.93	5
Alaska	68	$81.03	$47.65	4
Mississippi	50	$55.82	$46.69	2
Vermont	34	$59.68	$46.58	1
North Dakota	21	$66.88	$54.89	1
Montana	21	$78.40	$46.66	1

Related codes

99490Chronic care management services$59.70
99439Chronic care management services for two or more chronic conditions$46.13
99497Advance care planning$73.95
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

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.