Only 4.6% of Medicare practitioners billed for advance care planning in 2021, up from 1.8% in 2016. The Permanente Journal study behind those figures covers 2,688,409 practitioner-year records from 2016 to 2021, and CMS now proposes new billing codes for this service starting in 2027.
Advance care planning is a conversation about a patient's wishes for future care. Medicare pays for it under two codes, CPT 99497 for the first 30 minutes and 99498 for each added 30 minutes. This post covers who bills the codes, what they pay, and what the proposed 2027 rule changes for practices that use clinical staff.
How many practitioners billed advance care planning?
In a 2025 article in The Permanente Journal, Nan Wang and colleagues analyzed CMS Medicare Provider Utilization and Payment files for 2016 through 2021. The share of practitioners billing any advance care planning rose from 1.76% in 2016 to 4.56% in 2021. That is a gain of 2.8 percentage points over five years.
The 4.6% base is all practitioners in the file, so about 1 in 22 billed the codes in 2021. The sample held 1,061,877 primary care observations and 1,160,324 advanced practice practitioner observations. Those two groups made up most of the 2,688,409 total. The authors counted each practitioner once per year.
The data end in 2021. The Permanente Journal paper does not report later years, and it does not report payment amounts or rates per 1,000 beneficiaries.
Billing share by specialty group in 2021
Billing varied by a factor of about 70 between groups. Hospice and palliative medicine led at 36.94%, and non-cancer terminal disease specialties trailed at 0.53%. Even in hospice and palliative medicine, roughly 63.1% of practitioners billed no advance care planning in 2021.
| Practitioner group | Share billing any ACP, 2021 | Observations, 2016 to 2021 |
|---|---|---|
| Hospice and palliative medicine | 36.9% | 7,320 |
| Geriatrics | 14.4% | 12,105 |
| Primary care | 7.7% | 1,061,877 |
| Advanced practice practitioners | 3.3% | 1,160,324 |
| Cancer-related specialties | 1.1% | 113,012 |
| Non-cancer terminal disease specialties | 0.5% | 333,771 |
Source: Wang et al., The Permanente Journal, August 11, 2025, based on CMS Medicare Provider Utilization and Payment files. Percentages are shares of practitioners in each group who billed codes 99497 or 99498.
Primary care billed at 7.7%, about one fifth the rate of hospice and palliative medicine and 2.3 times the rate of advanced practice practitioners. The authors pool nurse practitioners and physician assistants into one group, so the study cannot split them.
Metro and nonmetro visit volume
The study also counted advance care planning visits per billing practitioner. It split practitioners into metropolitan and nonmetropolitan groups using RUCA codes, where codes 1 to 3 count as metro. Nonmetro practitioners who billed the codes often billed more of them.
| Practitioner group | Visits per billing practitioner, metro | Visits per billing practitioner, nonmetro |
|---|---|---|
| Hospice and palliative medicine | 75.0 | 66.7 |
| Advanced practice practitioners | 70.2 | 54.8 |
| Cancer-related specialties | 53.6 | 142.9 |
| Non-cancer terminal disease specialties | 82.8 | 107.0 |
| Primary care | 91.4 | 99.3 |
| Geriatrics | 73.8 | 87.0 |
Source: Wang et al., The Permanente Journal, August 11, 2025. The authors report P less than .001 for the advanced practice, cancer-related, and primary care differences. The differences for hospice and palliative medicine (P = .650), non-cancer terminal disease (P = .200), and geriatrics (P = .40) were not statistically significant.
Cancer-related specialties show the widest gap, at 142.9 nonmetro visits against 53.6 metro visits per billing practitioner. Hospice and palliative medicine and advanced practice practitioners billed fewer visits in nonmetro areas, and only the advanced practice gap was statistically significant.
What Medicare pays for 99497 and 99498
ThoroughCare's February 25, 2026 guide lists 2026 national average payments of $87 for 99497 and $78 for 99498. It says the first rate rose by more than $7 from 2025 and the second by more than $9. Local rates differ, so a practice should check the CMS fee schedule lookup for its own area.
Code 99497 covers a 30-minute face-to-face session with at least 16 minutes of documented time. Code 99498 is an add-on for each further 30 minutes, with at least 16 minutes of documented time past the first 30. ThoroughCare also notes that when the service happens during an Initial or Subsequent Annual Wellness Visit, it is fully covered for patients under Medicare Part B.
At $87 per first session, a practice that bills 50 sessions a year collects about $4,350 from the base code alone. The study's billing practitioners averaged between 53.6 and 142.9 visits per year, depending on group and setting.
What CMS proposes for 2027
CMS released the CY 2027 Medicare Physician Fee Schedule proposed rule on July 14, 2026. Comments were due September 14, 2026. The AAFP expects the final rule around November 1, 2026, with an effective date of January 1, 2027.
Applied Policy's summary of the rule says CMS would create two new HCPCS codes, GACP1 and GACP2, for advance care planning that clinical staff furnish under the direct supervision of the billing practitioner. The existing codes 99497 and 99498 would cover only time the billing practitioner spends personally. CMS proposes work RVUs of 1.00 for GACP1 and 0.70 for GACP2, with 20 minutes of clinical labor in the direct practice expense for each. The AAFP summary describes GACP1 as the first 20 minutes and GACP2 as each added 20 minutes.
A practice could report the new G-codes and codes 99497 and 99498 together if the practitioner and the staff member each meet their own time thresholds. CMS also proposes adding both G-codes to the Medicare telehealth services list. It asks for comment on whether one code for the combined time would fit practice better.
The same rule changes the base payment rate. The AAFP reports a 2027 conversion factor of about $33 for qualifying alternative payment model participants, down 1.2%. The non-APM factor falls a projected 1.7%. The AAFP attributes both cuts to the expiration of the temporary 2.5% payment increase that Congress enacted.
Sources
- The Permanente Journal, Physician Billing for Advance Care Planning Among Medicare Fee-For-Service Beneficiaries, 2016-2021, August 11, 2025
- ThoroughCare, 2026 Advance Care Planning CPT Codes and Reimbursement Rates, February 25, 2026
- Applied Policy, CMS Issues CY 2027 Physician Fee Schedule Proposed Rule, July 14, 2026
- AAFP, Summary of the CY 2027 Medicare Physician Fee Schedule Proposed Rule, July 2026
Talk to us
Fifteen minutes about your practice and the systems you run.