CPT / HCPCS code · 2026 CMS data · Verified 2026-08-31
CPT 99497 RVU and Medicare Payment (2026)
Advncd care plan 30 min — 1.5 work RVU, about $86.84 non-facility Medicare payment at the 2026 conversion factor.
- Work RVU
- 1.5
- PE RVU (non-facility)
- 1.01
- PE RVU (facility)
- 0.38
- MP RVU
- 0.09
- Office payment
- $86.84
- Facility payment
- $65.8
How the payment is calculated
Total RVU is work plus practice expense plus malpractice, each adjusted by its GPCI factor, then multiplied by the conversion factor. For 99497 in a non-facility setting with national GPCI: (1.5 + 1.01 + 0.09) × $33.4009 ≈ $86.84. The same code in a facility setting pays about $65.8 because facility PE RVU (0.38) replaces office PE RVU.
What changes by locality
GPCI moves 99497 non-facility payment from $80.63 to $112.74 across CMS localities — from Arkansas to Alaska. Check your exact locality in the GPCI calculator rather than using a state average.
Related codes
Checking a different code or locality? Open the full RVU calculator to run any of the 7,790 CPT/HCPCS codes with your own GPCI factors.
Frequently asked questions
What is the 2026 work RVU for CPT 99497?
1.5. Work RVU measures physician time, skill, and intensity — it does not change by setting or locality. Total payment adds practice expense and malpractice RVUs plus the conversion factor.
How much does Medicare pay for CPT 99497 in 2026?
About $86.84 non-facility ($65.8 facility) at national GPCI with the 2026 $33.4009 conversion factor. Your locality GPCI moves the number — see the range above.
Does the work RVU change between office and facility?
No. Work RVU (1.5) and malpractice RVU stay fixed; only practice expense changes (1.01 office vs 0.38 facility). That is the entire office-vs-facility payment gap.