Your patients can arrive having already thought it through.
CareGoals is a 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 2026Their words first. Your worksheet second.
When 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 answers you need first, on top
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.
Room for what CMS asks you to document
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.
Private lines stay private
The patient’s message to their family and anything they marked unfinished stay off the packet. Those are theirs to share.
Or as text, before they arrive
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.
- Health care agent
- Ana, my daughter (has been told)
- If seriously ill and not expected to recover
- Focus on comfort, not prolonging life
- CPR
- Only if there’s a real chance
- Does not want
- A breathing machine for a long time; A feeding tube for a long time; To be alone at the end
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.
The thinking happens at home. The conversation happens with you.
They write it at home
On their own phone or computer, in about 20 minutes, one short card at a time, ideally with the person who would speak for them. They tap their answers; nothing has to be typed. Their answers stay on their device. When they finish, they print the visit packet or copy it into a portal message to your office.
You start from their words
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.
They bring it back
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.
What CMS says about 99497 and 99498
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 |
Medicare waives the patient’s deductible and coinsurance when the planning is:
- On the same day as the covered AWV (G0438 or G0439)
- By the same provider
- Billed with modifier 33, on the same claim as the AWV
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.
Who can bill
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.
Who’s in the room
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.
What to document
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.
What not to count
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.
Diagnosis and frequency
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.
Where
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.
Health centers and clinics
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.
Patients in hospice
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.
If your practice runs on memberships
Where you stand with Medicare decides whether any of the billing above applies to you.
Medicare won’t pay for it
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.
The same rules as any practice
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.
Two ways to put it in their hands
Both are yours to use and change as you like. Nothing here asks for your name or email.
A message for your portal or newsletter
Send it before annual visits, or after a new diagnosis.
A card for the waiting room
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. No account, and your answers stay on your device.
Bring it to your next visit, and we can talk it through together.
What CareGoals isn’t
A legal form or a medical order
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.
A billing or coding service
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.
Connected to your records
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.
AI in the questions
The cards run in the patient’s browser and record what they tap. No AI writes or changes their answers.
Try it yourself first.
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.
Where this comes from
- Centers for Medicare & Medicaid Services, Advance Care Planning, MLN fact sheet MLN909289, March 2026: who can bill, documentation, time thresholds, settings, the AWV cost-sharing waiver, frequency, FQHC/RHC and hospice rules.
- Medicare.gov, Advance care planning (what patients pay) and Concierge care (membership fees and Medicare-covered services).
- Novitas Solutions (Medicare Administrative Contractor), opting out of Medicare and private contracts.
- CMS, CY 2027 Physician Fee Schedule proposed rule fact sheet (proposed, not final).
- The physician advance-directive figure is cited on Why it’s hard. CPT® is a registered trademark of the American Medical Association. Reviewed September 21, 2026.
CareGoals provides advance care planning tools, not medical, legal, or billing advice. It isn’t affiliated with CMS or Medicare.