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Advance Care Planning Discussion

North Carolina rates for HCPCS 99497

A face-to-face conversation between a clinician and a patient, a family member or a person appointed to decide on their behalf, about the patient's wishes for future medical care. It covers explaining and discussing advance directives such as a living will or naming a healthcare proxy, and completing those forms if the patient wishes. It covers the first substantial block of time spent on the discussion.

Rates data updated July 2026.

Facilitymedian $89 · 10th–90th $66$1740%10%10th90th$89Professionalmedian $105 · 10th–90th $62$2000%10%10th90th$105$10.0$20.0$50.0$100.0$200.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$83.18
Median
$112.20
Typical High
$208.93
Aetna
Setting
Professional
Modifier
Global
Typical Low
$58.88
Median
$75.86
Typical High
$173.78
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$35.48
Median
$72.44
Typical High
$194.98
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$83.18
Typical High
$134.90
Ambetter
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$60.26
Median
$83.18
Typical High
$131.83
BCBS
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$128.82
Typical High
$199.53
Cigna
Setting
Facility
Modifier
Global
Typical Low
$93.33
Median
$93.33
Typical High
$93.33
Cigna
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$104.71
Typical High
$181.97
Medcost
Setting
Professional
Modifier
Global
Typical Low
$158.49
Median
$158.49
Typical High
$158.49
Medcost
Setting
Facility
Modifier
Global
Typical Low
$64.57
Median
$85.11
Typical High
$141.25
Medcost
Setting
Professional
Modifier
Global
Typical Low
$208.93
Median
$208.93
Typical High
$467.74
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$69.18
Median
$120.23
Typical High
$181.97
United
Setting
Facility
Modifier
Global
Typical Low
$89.13
Median
$95.50
Typical High
$125.89
United
Setting
Professional
Modifier
Global
Typical Low
$66.07
Median
$89.13
Typical High
$147.91
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$79.43
Median
$95.50
Typical High
$100.00
Wellcare
Setting
Facility
Modifier
Global
Typical Low
$478.63
Median
$478.63
Typical High
$478.63
Wellcare
Setting
Professional
Modifier
Global
Typical Low
$524.81
Median
$524.81
Typical High
$524.81