Locality

or ZIP

Show values as

Switch every figure between Medicare dollars and work RVUs.

Conversion factor

99497

Advncd care plan 30 min

Add to my model

Code typePrimary

Payment statusActive (A)

Global periodNone

Pricing with Related Codes

Line

Qty

Global fee

Pro fee

Primary99497Advncd care plan 30 min

$86.84

$65.80

Add-on96160Pt-focused hlth risk assmt

$3.01/ unit

Add-on96161Caregiver health risk assmt

$3.34/ unit

Add-on99498Advncd care plan addl 30 min

$78.16/ unit

$63.46/ unit

Whole procedure · 1.50 wRVU credited

$86.84

$65.80

RVU Breakdown

Component

Office

Facility

Work

1.50

Practice expense

1.01

0.38

Malpractice

0.09

Total RVU

2.60

1.97

Payment Policy & Modifiers

Allowed adjustments

Assistant surgeon -80/81/8216% · documented

Assistant at surgery (mod 80/81/82) paid at 16% if medical necessity is documented.

Not applicable to this code

Bilateral -50Multiple procedure Co-surgeon -62Team surgeon -66Prof / tech split

In plain English

Office vs. facility

Where the service happens. In your own clinic (office), Medicare also pays you for the room, staff and supplies — so it's higher. In a hospital or ASC, the facility bills that part separately.

wRVU

Work Relative Value Units — the physician-effort share of a code. Most employment contracts pay a set dollar amount per wRVU, independent of Medicare's rate.

Add-on codes

Billed only alongside a primary. 96160 adds each extra unit — the stepper adds them to the whole-procedure total.

Conversion factor

The dollars-per-RVU Medicare multiplies by. Set once, it flows through every figure on this page. The QP rate applies to clinicians who qualify as Advanced APM participants — a small annual boost.

GPCI

Geographic Practice Cost Index — adjusts the work, practice-expense and malpractice RVUs for your locality's cost of living before they're multiplied by the conversion factor.

How payment is computed

Each RVU is scaled by your locality's GPCI, summed, then multiplied by the conversion factor:

(work·wGPCI
+ PE·peGPCI
+ MP·mpGPCI) × CF

This code's Global fee

(1.50·1.000
+ 1.01·1.000
+ 0.09·1.000) × $33.40 = $86.84

Full methodology — how we apply CMS's rules →