Price Checker / CPT 99497
CPT 99497 — Advncd care plan 30 min
2026 Medicare Physician Fee Schedule rates and hospital pricing data
$66
What Medicare pays in a hospital/ASC setting
$87
What Medicare pays in a physician's office
$5,310
Based on 5 hospital(s) in our database
What do these numbers mean?
The Medicare rateis what the federal government determines is a fair payment for this procedure. It's based on the Relative Value Unit (RVU) system, which accounts for physician work, practice expense, and malpractice cost. Hospitals and providers often charge 3-20x this amount. If your bill is significantly higher than the Medicare rate, you may have grounds to negotiate.
Hospital Charges for CPT 99497
From hospital-published transparency (MRF) files. These are the hospitals in our database that list this procedure.
| Hospital | Gross Charge | Cash Rate | vs Medicare |
|---|---|---|---|
| WTH Dyersburg Hospital , TN | — | $43 | 29358% |
| Broadlawns Cityville Urgent Care & Family Medicine , IA | $244 | $244 | 181% |
| Broadlawns Community Clinic at Drake , IA | $244 | $244 | 181% |
| Broadlawns East University Urgent Care & Family Medicine , IA | $244 | $244 | 181% |
| hebrew rehabilitation center hospital , MA | $235 | $235 | 171% |
Were you billed for this procedure?
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About CPT 99497
CPT code 99497 refers to “Advncd care plan 30 min”. Under the 2026 Medicare Physician Fee Schedule, this procedure is reimbursed at $66 in a facility (hospital or ambulatory surgery center) and $87in a non-facility (physician's office) setting.
These rates are set by CMS (Centers for Medicare & Medicaid Services) and represent what the government considers a fair payment for this service. While commercial insurance typically pays somewhat more than Medicare, many hospitals charge significantly higher amounts — sometimes 10-50x the Medicare rate.
What to do if you were overcharged
- Upload your bill— we'll identify this code and compare it against the rates shown above.
- Get a dispute letter— citing the Medicare rate and your hospital's own published pricing data.
- Negotiate or let us handle it — 25% of savings, no savings = no fee.