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Advance Care Planning Discussion

Pennsylvania 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 $66 · 10th–90th $60$1350%20%10th90th$66Professionalmedian $79 · 10th–90th $60$1410%20%10th90th$79$10.0$50.0$200.0$1.0K$5.0K$20.0K

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
$60.26
Median
$66.07
Typical High
$134.90
Aetna
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$75.86
Typical High
$138.04
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$64.57
Median
$83.18
Typical High
$257.04
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$77.62
Typical High
$100.00
Ambetter
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$54.95
Median
$70.79
Typical High
$91.20
AmeriHealth
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$83.18
Typical High
$89.13
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$8,511.38
Median
$8,511.38
Typical High
$77,624.71
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$85.11
Typical High
$138.04
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
$93.33
Typical High
$162.18
Emblem Health
Setting
Facility
Modifier
Global
Typical Low
$147.91
Median
$147.91
Typical High
$147.91
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$131.83
Typical High
$177.83
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$83.18
Median
$95.50
Typical High
$158.49
Highmark BCBS
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$83.18
Typical High
$112.20
Highmark BCBS
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$70.79
Median
$81.28
Typical High
$104.71
Independence Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$89.13
Typical High
$89.13
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$60.26
Median
$66.07
Typical High
$134.90
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$75.86
Typical High
$144.54
Martin's Point
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$66.07
Median
$85.11
Typical High
$263.03
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$69.18
Median
$114.82
Typical High
$181.97
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$74.13
Median
$81.28
Typical High
$93.33
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$74.13
Median
$81.28
Typical High
$85.11
United
Setting
Facility
Modifier
Global
Typical Low
$89.13
Median
$263.03
Typical High
$363.08
United
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$89.13
Typical High
$158.49
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$95.50
Median
$100.00
Typical High
$134.90