CareGoals is a free planning tool your patients fill in before the visit, on their own device: who speaks for them, the care they’d want, and what matters most, in their own words. They bring you that document and a one-page worksheet for the advance care planning conversation. The conversation, the judgment, and the note stay yours.
The shortest advance care planning discussion CMS lets you bill as 99497. A unit counts once the midpoint of its 30 minutes passes; at 15 minutes or less, CMS says to bill a different E/M service instead. Time the patient spends writing at home doesn’t count. Time spent discussing it face to face, with the patient or the person who speaks for them, does.
CMS, Advance Care Planning fact sheet, MLN909289, March 2026When patients finish, they can print a visit packet: their Care Wishes document, then one page for you. The worksheet pulls up the answers you’d reach for first and leaves the rest for you to fill in during the visit.
The person they’ve named to speak for them and whether that person knows, their treatment preference if seriously ill and not expected to recover, CPR, and what they don’t want.
That the discussion was voluntary, your explanation of advance directives, who was present, and the time spent on advance care planning, with start and end times.
The patient’s message to their family and anything they marked unfinished stay off the packet. Those are theirs to share.
Patients can copy a plain-text version into a portal message to your office, so you can read it ahead of the visit.
The patient wrote the Care Wishes document on the pages before this one ahead of the visit, in their own words, using caregoals.com. It is a values document, not a medical order or a legal form.
The page continues with plan and follow-up, a line for what changed since any earlier planning visit, your signature, and a short billing reference taken from CMS’s fact sheet.
On their own phone or computer, in about 20 minutes, in five short sections. Their answers stay on their device. When they finish, they print the visit packet or copy it into a portal message to your office.
Not a blank form. Confirm who they’ve named, talk through what their answers mean medically, explain advance directives, and fill in the worksheet as you go: who was there, how long you spent, what was decided.
Patients can add a yearly reminder to their calendar to reread and update their wishes. When something has changed, the worksheet has a line for it, which is what CMS asks you to record when you bill again.
Summarized from CMS’s Advance Care Planning fact sheet for Original Medicare (MLN909289, March 2026) and Medicare.gov. It’s a reference, not billing advice: whether and how you bill is your decision, and Medicare Advantage, Medicaid, and commercial plans can set their own rules.
| Time discussing advance care planning | What CMS says to bill |
|---|---|
| 15 min or less | No advance care planning code. Bill a different E/M service, like an office visit. |
| 16–45 min | 99497 × 1 |
| 46–75 min | 99497 × 1 + 99498 × 1 |
| 76–105 min | 99497 × 1 + 99498 × 2 |
If the AWV is denied for exceeding the once-a-year limit, the deductible and coinsurance apply. Outside the AWV, advance care planning is a separate Part B service with the usual deductible and 20% coinsurance.
Physicians and nonphysician practitioners (nurse practitioners, physician assistants, clinical nurse specialists) whose scope of practice and Medicare benefit category include the service and who can bill Medicare independently. Hospitals can bill it too.
A voluntary, face-to-face discussion with the patient, or with a family member, caregiver, or surrogate as appropriate. You can discuss advance directives with or without completing forms.
That the discussion was voluntary, your explanation of advance directives, who was present, and the time spent discussing advance care planning face to face. The worksheet has a place for each.
Time spent actively managing other problems, and time on another time-based service done at the same time. You can bill an E/M visit and advance care planning in the same encounter when the times don’t overlap.
No specific diagnosis is required. There’s no limit on how often; when you bill it again, document the change in the patient’s health, their wishes, or both.
In an office, a hospital, a nursing home, or at home, and by telehealth under the telehealth rules in effect on the date of service.
Federally Qualified Health Centers and Rural Health Clinics are paid for advance care planning inside their all-inclusive rate or prospective payment system, as part of the bundled services.
You can bill it under Part B only if you aren’t employed by the hospice. Physicians employed by the hospice, or under arrangement with it, bill it on the hospice’s claim (type of bill 81X or 82X).
CMS’s CY 2027 Physician Fee Schedule proposed rule would create two new HCPCS codes for advance care planning furnished by clinical staff under the direct supervision of the billing practitioner, and would limit 99497 and 99498 to time the billing practitioner personally spends. Check the final rule before relying on either.
CareGoals doesn’t bill, code, or submit anything, and it can’t tell you whether a particular visit qualifies. The sources are listed at the bottom of this page.
Where you stand with Medicare decides whether any of the billing above applies to you.
Medicare makes no payment, to you or to your patient, for services you furnish under your private contracts, and advance care planning is no exception. Opt-out runs in two-year periods. The conversation can still be part of what your membership covers, and the worksheet documents it the same way.
You can bill 99497 and 99498 for your Medicare patients under the rules above. Medicare.gov is explicit that a membership fee can’t include charges for items or services Medicare covers.
Not sure which applies? CMS publishes the list of practitioners who have opted out. For patients with other coverage, the plan’s own rules decide.
Both are free to use and change as you like. Nothing here asks for your name or email.
Send it before annual visits, or after a new diagnosis.
Prints two to a letter page on plain paper. Cut along the dashed line.
Write down who would speak for you, the care you’d want and wouldn’t, and what comfort means to you. About 20 minutes on your own phone. Free, and your answers stay on your device.
Bring it to your next visit, and we can talk it through together.
It’s a values document in the patient’s own words. To make it legally official, they copy it onto their state’s advance directive form. A POLST or MOLST is yours to complete when it fits.
CareGoals doesn’t bill, code, or review documents, and it doesn’t guarantee coverage or payment. The reference above is CMS’s guidance, summarized. The decision is yours.
Nothing flows into your EHR, and no one at CareGoals sees what your patients write. They bring it to you, and you document the visit in your own note.
The five sections are a plain form that runs in the patient’s browser. No AI writes or changes their answers.
About 20 minutes, on your own device. A 2026 review of two decades of studies found fewer than one in ten physicians had completed an advance directive of their own.
CareGoals provides advance care planning tools, not medical, legal, or billing advice. It isn’t affiliated with CMS or Medicare.