CPT 99498
Global ZZZ ActiveAdvncd care plan addl 30 min
CPT 99498 Billing & Documentation Guide
CPT code 99498 (Advncd care plan addl 30 min) is classified under E/M with a global period indicator of ZZZ. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 1.4, a non-facility practice expense RVU of 0.85, and a malpractice RVU of 0.09, a total non-facility RVU of 2.34 and facility RVU of 1.9. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $79.92, though rates vary from $72.7 to $102.03 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 99498, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 99498 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
Add-on code (global concept does not apply)
MUE Limit (Medically Unlikely Edits)
Submitting more than 3 units of 99498 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 99498
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 1.4 | 1.4 |
| Practice Expense RVU | 0.85 | 0.41 |
| Malpractice RVU | 0.09 | 0.09 |
| Total RVU | 2.34 | 1.9 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 99498
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $83.66 | $66.27 | $80.28 - $94.46 | 29 |
| Florida | $81.1 | $66.35 | $78.42 - $83.92 | 3 |
| Georgia | $77.52 | $63.5 | $75.67 - $79.36 | 2 |
| Illinois | $80.1 | $65.9 | $77.38 - $82.52 | 4 |
| Michigan | $77.66 | $63.85 | $76.08 - $79.23 | 2 |
| North Carolina | $75.17 | $61.46 | $75.17 - $75.17 | 1 |
| New York | $84.74 | $68.34 | $75.85 - $89.09 | 5 |
| Ohio | $75.71 | $62.29 | $75.71 - $75.71 | 1 |
| Pennsylvania | $78.2 | $63.81 | $75.66 - $80.74 | 2 |
| Texas | $77.76 | $63.29 | $75.39 - $79.56 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 99498
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 99498 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0469T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0469T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 36591 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 36591 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 36592 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 36592 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 93792 | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 93792 | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 93793 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 93793 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
Frequently Asked Questions, CPT 99498
What does CPT code 99498 mean? +
CPT code 99498 represents: Advncd care plan addl 30 min. It's in the E/M category with a global period of ZZZ.
What is the Medicare reimbursement for CPT 99498? +
The 2026 Medicare national average non-facility payment for CPT 99498 is $79.92. Rates range from $72.7 to $102.03 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 99498? +
E/M codes commonly use modifier 25 (significant separately identifiable E/M on same day as a procedure), 57 (decision for major surgery), 24 (unrelated E/M during global period), 95 (synchronous audio+video telehealth), 93 (audio-only telehealth), and AI (principal physician of record on admission). Surgical modifiers like 50, 51, 59 do not apply to E/M.
What bundling edits apply to CPT 99498? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
Get the full PayerReady toolkit
Free access to CPT/ICD-10 lookup, denial appeals, fee comparator, and claim auditing with credentialing enrollment.
Start free →Run this code through our claim audit tool
Check NCCI bundling, MUE limits, and modifier logic before submission.
Try the auditor →Did this page help?
Quick signal so we know what to improve.
If you want a code reference page that doesn't exist yet, email coding@payerready.com.
Tell us what's missing or wrong: coding@payerready.com. We respond within 5 business days.
Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
Powered by 11K CPT · 98K ICD-10 · 860K MPFS rates · 4.5M NCCI edits · 9.5M NPIs. Our data methodology · About our coding team