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CPT 99498
Description, Billing Rules, and Use Cases

CPT 99498 is used to report each additional 30-minute block of Advance Care Planning (ACP) services that follow the initial 30 minutes billed under CPT 99497. This add-on code reflects continued face-to-face discussions with patients or surrogates regarding future medical care decisions, treatment goals, and the completion of advance directives.

What is CPT Code 99498?

CPT 99498 is a time-based add-on code that extends billing for Advance Care Planning services beyond the first 30 minutes. It may only be billed in conjunction with CPT 99497, and is used when the provider spends significant additional time leading voluntary discussions about:

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  • Resuscitation and life support preferences

  • Mechanical ventilation, tube feeding, and dialysis

  • Living wills, POLST forms, or state-specific directive tools

  • Designation of surrogate decision-makers or health care agents

  • Revisiting or revising previously established directives

 

CPT 99498 can be used:

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  • During the same encounter as CPT 99497

  • When ACP services extend to 61+ minutes of total provider time

  • Repeated as needed in 30-minute increments, provided time is clearly documented

 

CPT 99498 cannot be billed as a standalone service — it must follow a claim for CPT 99497 during the same encounter or calendar date.

CPT 99498 Billing Requirements and Eligibility

CPT 99498 is a time-based add-on code used to bill for each additional 30 minutes of Advance Care Planning (ACP) performed after the first 30 minutes reported with CPT 99497. This service must be face-to-face, voluntary, and medically appropriate, and it must involve the patient or their legal representative.

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ACP services under 99498 often occur in extended care conversations, discharge planning, or complex family decision-making.

Patient Eligibility Criteria

To qualify for CPT 99498:

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  • The patient must already meet the criteria for CPT 99497 (voluntary ACP, face-to-face, cognitively appropriate or legally represented)

  • The ACP discussion must continue beyond 30 minutes, with additional time documented

  • Extended conversations may occur when:

    • Complex care decisions are involved

    • Multiple stakeholders (family, surrogate, care team) are present

    • ACP documents are revised or re-reviewed due to a change in medical condition

Service and Documentation Requirements

To report CPT 99498:

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  • At least 46 minutes of total face-to-face ACP time must be documented

    • The first 30 minutes is billed under 99497

    • CPT 99498 requires an additional 16 minutes (to meet midpoint threshold)

  • Additional units of 99498 may be billed for each full 30-minute block beyond that

  • All time must be:

    • Personally performed by a physician or QHP

    • Face-to-face, not asynchronous or telephonic

    • Clearly separated from other services such as E/M time

Billing Frequency and Code Combinations

  • CPT 99498 must be billed in the same encounter as CPT 99497

  • It may be repeated if:

    • Additional 30-minute blocks of ACP are delivered

    • Documentation supports the medical necessity and time spent

  • Common combinations include:

    • 99497 (first 30 min) + 99498 (31–60 min)

    • 99497 + 99498 ×2 (61–90 min), and so on

  • Can be billed with or without an E/M code or Annual Wellness Visit, but ACP must be distinct

Who Can Bill CPT 99498?

Only the following may report CPT 99498:

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  • Physicians

  • Nurse Practitioners (NPs)

  • Physician Assistants (PAs)

  • Other Qualified Healthcare Professionals (QHPs)

 

Time must be personally performed — time from clinical staff or care managers cannot be included toward the 99498 threshold.

CPT 99498 Billing Documentation Checklist

To compliantly bill CPT 99498, ensure the following items are included in the patient’s record:

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  • Reference to CPT 99497 billed in the same encounter

    • 99498 may only be reported as an add-on code

    • Clearly link the extended ACP time to the original 99497 service

  • Total time spent in ACP services

    • Cumulative provider time must exceed 45 minutes

    • A single unit of 99498 requires at least 16 minutes beyond the first 30

    • Additional units require documentation for each additional 30-minute block

  • Breakdown of extended conversation content

    • What additional topics were discussed (e.g., detailed POLST sections, revisiting resuscitation preferences, clarifying conflicts among surrogates)

    • Summary of clinical recommendations and patient or surrogate decisions

    • Indication of patient or family understanding and agreement

  • Confirmation of voluntary participation and face-to-face interaction

    • Notation that the discussion was initiated voluntarily and conducted in real-time

    • May include patient or legally recognized decision-maker

    • Clearly state that the conversation was not coerced or incentivized

  • Outcome of extended ACP session

    • Whether new documents were signed, amended, or reviewed

    • Actionable next steps, such as uploading advance directives or scheduling follow-ups

    • Notes about family dynamics, care conflicts, or ethics consults (if applicable)

  • Provider credentials and billing validation

    • Time must be personally performed by a physician or QHP

    • Staff time may not be counted toward 99498

    • Ensure no double-counting with E/M or discharge services

CPT 99498 Time Thresholds and Code Combinations

CPT 99498 is a time-based add-on code and must be billed with CPT 99497. It is used when Advance Care Planning (ACP) services exceed the first 30 minutes, and additional time is clearly documented in 30-minute increments.

Table showing CPT 99498 billing scenarios based on total time, required pairing with CPT 99497, and provider qualifications.

Important to Note:

  • CPT 99498 may not be reported without 99497 in the same encounter

  • A single unit of 99498 requires a minimum of 46 total minutes of face-to-face provider time

  • Additional units may be billed for every additional 30-minute block beyond the first

  • Only physicians or QHPs may perform and bill the time

When to Use CPT 99498:
Common Scenarios and Use Cases

CPT 99498 is used to extend billing for Advance Care Planning (ACP) when the provider spends more than 45 minutes in face-to-face discussions. It is always billed alongside CPT 99497 and is commonly used in complex family, end-of-life, or transitional care planning situations.

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Here are examples of how CPT 99498 is used in practice:

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  • Extended ACP Following Acute Hospitalization
    A hospitalist:

    • Leads a multi-family discussion about hospice enrollment and escalation preferences

    • Revisits goals of care and confirms health care proxy for legal documentation

    • Reviews prior directive and initiates a revised POLST form
      Total provider time: 70 minutes
      Billing: 99497 + 99498

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  • Comprehensive Planning for ALS Diagnosis
    A neurologist:

    • Reviews long-term disease progression, ventilator decisions, and nutrition plans

    • Includes the spouse and adult children in an emotionally charged, values-based discussion

    • Documents future trach considerations and care location preferences
      Total provider time: 92 minutes
      Billing: 99497 + 99498 ×2

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  • ACP Across Language and Cultural Barriers
    A geriatric NP using an interpreter:

    • Leads a values-aligned ACP session with three generations present

    • Discusses CPR, palliative care, and surrogate responsibilities

    • Spends extended time confirming understanding and cultural alignment
      Total provider time: 105 minutes
      Billing: 99497 + 99498 ×2

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  • Elderly Patient With Complex Family Dynamics
    A primary care physician:

    • Moderates ACP with three adult children, all legal decision-makers

    • Discusses prior DNR confusion and re-establishes clear directives

    • Finalizes updated documentation with all parties present
      Total provider time: 128 minutes
      Billing: 99497 + 99498 ×3

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Common CPT 99498 Billing Mistakes
(and How to Avoid Them)

As a time-based add-on code, CPT 99498 is frequently misused or under-documented. Here are the most common issues to watch for — and how to bill it correctly.

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  • ❌ Billing CPT 99498 Without CPT 99497
    99498 is not a standalone code. It must be paired with 99497 in the same encounter and on the same claim. Submitting 99498 on its own will result in a denial.
     

  • ❌ Time Documented Under 46 Minutes Total
    You need at least 16 minutes beyond the initial 30 minutes (i.e., 46 minutes total) to qualify for the first unit of 99498. Anything less should be billed as 99497 only.
     

  • ❌ No Breakdown of Extended Discussion Content
    If documentation for the additional time just repeats what was captured under 99497, the claim may be denied. You must show progression or additional topics covered (e.g., deeper values clarification, advanced directive finalization, surrogate disputes, etc.).
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  • ❌ Staff Time Counted Toward 99498​
    Only time personally performed by a physician or QHP counts. Nursing, social work, or interpreter time may not be included unless the provider is actively leading the conversation.
     

  • ❌ Bundling With E/M Without Clear Time Separation
    If 99497 and 99498 are billed alongside an Evaluation & Management (E/M) code, the documentation must clearly delineate ACP time from the E/M visit to avoid duplicate billing scrutiny.

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