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Advance Care Planning Discussion

New York 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 $58$4790%20%10th90th$89Professionalmedian $83 · 10th–90th $59$1820%20%10th90th$83$0.1$0.5$2.0$10.0$50.0$200.0$1.0K

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
$57.54
Median
$89.13
Typical High
$416.87
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$478.63
Median
$478.63
Typical High
$478.63
Aetna
Setting
Professional
Modifier
Global
Typical Low
$57.54
Median
$77.62
Typical High
$165.96
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$63.10
Median
$83.18
Typical High
$173.78
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$58.88
Median
$72.44
Typical High
$91.20
Ambetter
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$56.23
Median
$72.44
Typical High
$87.10
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$64.57
Typical High
$134.90
CDPHP
Setting
Facility
Modifier
Global
Typical Low
$109.65
Median
$109.65
Typical High
$109.65
CDPHP
Setting
Professional
Modifier
Global
Typical Low
$109.65
Median
$109.65
Typical High
$120.23
Cigna
Setting
Facility
Modifier
Global
Typical Low
$93.33
Median
$93.33
Typical High
$93.33
Cigna
Setting
Professional
Modifier
Global
Typical Low
$66.07
Median
$109.65
Typical High
$208.93
Emblem Health
Setting
Facility
Modifier
Global
Typical Low
$0.10
Median
$0.10
Typical High
$107.15
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$120.23
Typical High
$177.83
Excellus BCBS
Setting
Facility
Modifier
Global
Typical Low
$77.62
Median
$77.62
Typical High
$91.20
Excellus BCBS
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$91.20
Typical High
$177.83
Fidelis
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$77.62
Median
$93.33
Typical High
$95.50
Highmark BCBS
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$112.20
Typical High
$151.36
Highmark BCBS
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$95.50
Median
$112.20
Typical High
$204.17
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$120.23
Typical High
$380.19
United
Setting
Facility
Modifier
Global
Typical Low
$75.86
Median
$89.13
Typical High
$281.84
United
Setting
Professional
Modifier
Global
Typical Low
$75.86
Median
$120.23
Typical High
$316.23
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$95.50
Median
$100.00
Typical High
$100.00
Univera
Setting
Facility
Modifier
Global
Typical Low
$66.07
Median
$72.44
Typical High
$123.03
Univera
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$91.20
Typical High
$173.78