Advance Care Planning Conversations
Last updated: February 2026
A conversation every patient deserves — and most providers never feel ready for.
Medicare created dedicated billing codes for advance care planning conversations — CPT 99497 and 99498 — with no annual frequency cap. Yet fewer than 5% of eligible Medicare beneficiaries have a billed ACP conversation each year. The gap isn't demand. It's provider readiness.
The opportunity
Medicare reimbursement per ACP conversation (CPT 99497)
CMS Physician Fee Schedule, 2026
No annual frequency limit on ACP billing under Medicare
CMS Medicare Policy
of eligible Medicare beneficiaries receive a billed ACP conversation annually
Health Affairs, 2021
Billing Codes
Advance care planning, first 30 minutes
Face-to-face with patient/surrogate/family
Advance care planning, each additional 30 minutes
Add-on code, use with 99497
What this means for your health system
per PCP per year
Based on 48 ACP conversations/year at $87 each (conservative pace)
for a 75-PCP health system
At moderate billing pace of 96 conversations per provider/year
JAMA Health Forum 2024: ACP training increased billing 11x (1.3% to 14%)
The conversation nobody practices.
Advance care planning is a clinical service with dedicated Medicare billing codes, yet most providers have never practiced it in a structured setting. The result: eligible patients go without documented preferences, families face crisis-point decisions without guidance, and hospitals miss conversations that Medicare specifically created billing codes to encourage.
Most internal medicine and family medicine residencies offer no dedicated ACP training module
Providers cite discomfort and lack of confidence as the primary barrier to initiating ACP
The average ACP conversation takes 16 minutes — well within the billing window — when providers are trained
Simulation-based training has been shown to significantly improve provider confidence in ACP conversations
Why simulation works
Practice builds confidence. Confidence changes behavior. Better conversations change outcomes.
Practice the Full Conversation
Simulate complete ACP discussions — from opening the topic to documenting preferences — in a realistic, voice-based format.
From Practice to Action
Providers who've practiced ACP conversations are more likely to initiate them consistently — and document them appropriately.
Reduce Family Conflict
Trained providers facilitate clearer preference documentation, reducing crisis-point family disagreements.
Scale Across Departments
Deploy ACP training across primary care, hospitalist, and palliative care teams without scheduling constraints.
The evidence
The Effects of Advance Care Planning on End-of-Life Care: A Systematic Review
Palliative Medicine (2014)
Systematic review of 113 studies found that advance care planning decreased life-sustaining treatment, increased hospice and palliative care use, and prevented hospitalization. Complex ACP interventions increased compliance with patients' end-of-life wishes.
of patients who received ACP had end-of-life wishes known and followed
Detering et al., BMJ, 2010
reduction in ICU admission rates when end-of-life discussions occur
Wright et al., JAMA, 2008
average savings per admission with palliative care consultation
Morrison et al., Archives of Internal Medicine, 2008
Frequently Asked Questions
What is advance care planning?
Advance care planning (ACP) is a process in which patients, their families, and their healthcare providers discuss and document preferences for future medical care — particularly care desired near the end of life. ACP conversations cover topics like resuscitation preferences, comfort care goals, and designation of a healthcare proxy. Medicare reimburses these conversations under CPT codes 99497 and 99498.
What are the CPT codes for advance care planning?
Medicare reimburses advance care planning under two CPT codes: 99497 covers the first 30 minutes of face-to-face ACP discussion ($86.84 reimbursement), and 99498 is an add-on code for each additional 30 minutes ($74.83). There is no annual frequency limit on ACP billing under Medicare.
How much does Medicare reimburse for ACP conversations?
Medicare reimburses approximately $87 for the initial 30-minute ACP conversation (CPT 99497) and $75 for each additional 30 minutes (CPT 99498). There is no annual cap — providers can bill for ACP conversations as often as clinically appropriate. Despite this, fewer than 5% of eligible Medicare beneficiaries receive a billed ACP conversation annually (Health Affairs, 2021).
Why don't more providers bill for advance care planning?
The primary barrier to ACP billing is provider readiness, not patient demand. Most internal medicine and family medicine residencies offer no dedicated ACP training module. Providers consistently cite discomfort and lack of confidence as the primary barrier to initiating ACP conversations. When providers receive structured ACP training, billing rates increase significantly — one study in JAMA Health Forum (2024) found that ACP training increased billing 11x, from 1.3% to 14% of eligible visits.
Related Insights
End-of-Life Conversations: Practice Makes Progress
EOL conversations are low-frequency, high-stakes events. Traditional training models cant provide the practice clinicians need.
The ROI of Communication Training: By the Numbers
The business case for communication training is clear: reduced malpractice risk, improved HCAHPS scores, and better outcomes.