Summary of Reimbursement for CPT Code 99497 for 17 Patients
| ID | Qualified Provider ACP Time (minutes) Spent | RN ACP Time (minutes) Spent | CPT 99497 Billed and Reimbursed | Actual Reimbursed Dollars | Payers*† |
|---|---|---|---|---|---|
| 1 | 30 | 0 | Yes | $61.97 | Medicare & Supplement |
| 2 | 30 | 0 | Yes | $72.90 | Medicare & Supplement |
| 3 | 30 | 0 | Yes | $61.97 | Medicare & Supplement |
| 4 | 30 | 0 | Yes | $76.42 | Medicare Replacement |
| 5 | 0 | 16 | No | $0.00 | Private |
| 6 | 0 | 20 | No | $0.00 | Medicare Replacement |
| 7 | 0 | 25 | No | $0.00 | Medicare & Supplement |
| 8 | 0 | 25 | No | $0.00 | Medicare & Supplement |
| 9 | 0 | 25 | No | $0.00 | Medicaid |
| 10 | 0 | 25 | No | $0.00 | Private |
| 11 | 0 | 20 | No | $0.00 | Medicare |
| 12 | 0 | 20 | No | $0.00 | Medicare |
| 13 | 0 | 20 | No | $0.00 | Medicare & Supplement |
| 14 | 0 | 16 | No | $0.00 | Medicare & Supplement |
| 15 | 5 | 0 | No | $0.00 | Medicare & Supplement |
| 16 | 8 | 0 | No | $0.00 | Medicare |
| 17 | 25 | 0 | No | $0.00 | Medicare |
ACP, advance care planning; CPT, current procedural terminology, RN, registered nurse.
↵* Medicare & Supplement: Medicare is primary insurance; secondary commercial insurance or Medicaid were supplemental to the Medicare coverage and may have paid a portion of the total payment amount that is billed.
↵† Medicare Replacement: also known as Medicare Part C; a plan offered by private health insurance companies that provide the same coverage as Medicare Part A and Part B, and may include other benefits not normally covered by standard Medicare (e.g., prescription, dental).