CPT 99497 · professional fee

Advncd care plan 30 min (CPT 99497): negotiated rates by payer and state

What UnitedHealthcare, Aetna, Cigna and Blue Cross Blue Shield pay for CPT 99497, from their published in-network rate files.

Internal medicineSnapshot Aug 2026Professional fee only

National summary

Commercial in-network, four payers combined, professional fee

Median rate

$108

P10 to P90: $68 to $193

vs Medicare

125%

non-facility rate $86.84

Payer spread

1.66×

UHC $129 vs Aetna $78

State spread

2.6×

AK $202 to AL $76

5,418 sampled providers7,506 TINs51 statesSample-based · how this is calculated

What the data shows

Generated from this code's own numbers

UnitedHealthcare has the highest median for CPT 99497 in the files analyzed, at $129, 66% above Aetna ($78), the lowest of the 4 payers shown.

The state spread is 2.6×: Alaska has the highest median at $202 and Alabama the lowest at $76, a gap larger than the gap between the highest and lowest payer.

Commercial rates run 125% of the Medicare non-facility rate ($86.84), which ranks 160th of 228 tracked codes by commercial-to-Medicare ratio.

Rates are tightest within Aetna (interquartile range $31) and widest within Blue Cross Blue Shield ($59).

This is a top-15 code for internal medicine by Medicare allowed dollars, so it carries real revenue weight for that specialty.

Rates by payer

Median of per-provider median rates, with interquartile range

Payer	Median	P25	P75	vs national	Rank	Providers	Position
UnitedHealthcare	$129	$101	$170	+19%	1	4,250	148% of Medicare
Cigna	$117	$87	$148	+8%	2	3,481	134% of Medicare
Blue Cross Blue Shield	$100	$80	$139	-8%	3	4,098	115% of Medicare
Aetna	$78	$69	$100	-28%	4	2,910	89% of Medicare

Rate distribution

Box = P25 to P75, whiskers = P10 to P90, tick = median, dashed line = Medicare non-facility ($86.84)

Rates by state

Median across payers · 51 states with enough data

Rank	State	Median	vs national	Highest payer	Lowest payer	Providers
1	Alaska	$202	+86%	UHC	Aetna	97
2	Wisconsin	$196	+80%	UHC	Aetna	106
3	Oregon	$174	+60%	UHC	Aetna	98
4	Minnesota	$170	+57%	UHC	Aetna	112
5	Washington	$160	+47%	UHC	Aetna	109
6	Nebraska	$154	+42%	UHC	Aetna	89
7	North Dakota	$153	+41%	BCBS	Aetna	108
8	Massachusetts	$140	+30%	UHC	Aetna	121
9	New Hampshire	$138	+27%	UHC	Aetna	110
10	North Carolina	$137	+26%	UHC	Aetna	123
11	Georgia	$136	+25%	UHC	Aetna	120
12	South Dakota	$135	+25%	UHC	Aetna	123
13	Wyoming	$134	+23%	UHC	Aetna	104
14	Idaho	$125	+16%	Cigna	Aetna	109
15	District of Columbia	$124	+14%	UHC	BCBS	82
16	Colorado	$122	+12%	UHC	Aetna	114
17	Vermont	$120	+11%	UHC	BCBS	100
18	Maine	$119	+10%	UHC	Aetna	120
19	Montana	$118	+9%	UHC	BCBS	102
20	California	$117	+8%	Cigna	Aetna	97
21	Utah	$115	+6%	Cigna	BCBS	104
22	South Carolina	$113	+4%	BCBS	Aetna	97
23	New Mexico	$113	+4%	UHC	Aetna	97
24	Connecticut	$111	+3%	UHC	Aetna	118
25	Pennsylvania	$110	+1%	UHC	Aetna	108
26	New Jersey	$108	-1%	BCBS	Aetna	113
27	Iowa	$107	-2%	UHC	Aetna	99
28	Kansas	$105	-3%	UHC	Aetna	98
29	Arkansas	$105	-3%	UHC	BCBS	120
30	Hawaii	$103	-5%	UHC	BCBS	76
31	Oklahoma	$100	-8%	UHC	Cigna	109
32	Missouri	$99	-8%	UHC	Aetna	113
33	Tennessee	$99	-9%	UHC	Aetna	105
34	New York	$98	-9%	UHC	Aetna	115
35	Virginia	$97	-11%	UHC	Aetna	97
36	Illinois	$94	-13%	UHC	BCBS	86
37	Maryland	$94	-13%	Cigna	BCBS	94
38	Ohio	$93	-14%	UHC	BCBS	120
39	Indiana	$91	-16%	UHC	Aetna	121
40	West Virginia	$91	-16%	UHC	Aetna	114
41	Rhode Island	$91	-16%	UHC	BCBS	97
42	Louisiana	$89	-18%	UHC	Aetna	111
43	Kentucky	$88	-19%	UHC	BCBS	127
44	Delaware	$86	-21%	UHC	BCBS	107
45	Nevada	$84	-22%	BCBS	Aetna	105
46	Mississippi	$82	-24%	UHC	Aetna	99
47	Florida	$82	-25%	UHC	Cigna	102
48	Michigan	$81	-25%	UHC	BCBS	103
49	Texas	$80	-26%	UHC	BCBS	121
50	Arizona	$76	-30%	UHC	BCBS	96
51	Alabama	$76	-30%	Cigna	Aetna	102

Frequently asked questions

Answers use this page's data

Which payer has the highest median rate for CPT 99497?

In the files we analyzed, UnitedHealthcare, at a median of $129 across 4,250 sampled providers. Aetna is lowest at $78, 66% lower than the highest.

How does the commercial rate compare with Medicare?

The national median is 125% of the 2026 Medicare non-facility rate of $86.84.

Which state has the highest median for CPT 99497?

Alaska has the highest median at $202; Alabama has the lowest at $76.

Is this a professional fee?

These are professional (physician) fees only. Facility, device and implant payments are priced separately and are not included.

How current is this data?

It is the August 2026 snapshot of each payer's in-network rate file. Sources and filters are listed in the methodology below.

Methodology

How these numbers are calculated

Source: in-network negotiated-rate files published under the federal Transparency in Coverage rule, August 2026 snapshot: UnitedHealthcare Choice plans (74 files); Aetna commercial plans (70 files); Cigna national PPO (1 files); BCBS licensees' own-network files (5,387 files). Payer comparisons describe these files, not each payer's entire book of business.
Sample: rates come from a random sample of up to 150 providers per state and specialty. Counts on this page are sampled providers and TINs, not totals.
Which providers count: only providers in a specialty relevant to the code, because a rate in a payer file attaches to a provider group and is listed under every provider in that group.
Filters: fee-for-service, professional billing class, no modifier, negotiated or fee-schedule dollar rates. Rates outside 1% to 1,000% of the Medicare rate are excluded.
Statistic: one median rate per provider, then percentiles across providers. A cell is shown only with at least 15 sampled providers and 4 TINs.
Medicare benchmark: CY2026 national physician fee schedule, non-QPP conversion factor, unadjusted for locality. Where the non-facility rate is more than twice the facility rate (office rates that include device or supply cost), the facility rate is used so comparisons are like for like.

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