Cognitive Assessment & Care Plan Services

If your patient shows signs of cognitive impairment during a routine visit, Medicare covers a separate visit to more thoroughly assess your patient’s cognitive function and develop a care plan – use CPT code 99483 to bill for this service.

Effective January 1, 2021, Medicare increased payment for these services to $282 (maybe geographically adjusted) when provided in an office setting, added these services to the definition of primary care services in the Medicare Shared Savings Program, and permanently covered these services via telehealth. Use CPT code 99483 to bill for both in-person and telehealth services.

Detecting cognitive impairment is a required element of Medicare’s Annual Wellness Visit (AWV). You can also detect cognitive impairment as part of a routine visit through direct observation or by considering information from the patient, family, friends, caregivers, and others. You may also use a brief cognitive test and evaluate health disparities, chronic conditions, and other factors that contribute to increased risk of cognitive impairment.

If you detect cognitive impairment at an AWV or other routine visit, you may perform a more detailed cognitive assessment and develop a care plan during a separate visit. This additional evaluation may be helpful to diagnose a person with dementia, such as Alzheimer’s disease, and to identify treatable causes or co-occurring conditions such as depression or anxiety.

Any clinician eligible to report evaluation and management (E/M) services can offer this service. Eligible providers include:

  • Physicians (MD and DO)
  • Nurse practitioners
  • Clinical nurse specialists
  • Physician assistants

You can perform the assessment at any of these locations:

  • Office or outpatient setting
  • Private residence
  • Care facility
  • Rest home
  • Via telehealth

The cognitive assessment includes a detailed history and patient exam. There must be an independent historian for assessments and corresponding care plans provided under CPT code 99483. An independent historian can be a parent, spouse, guardian, or other individuals who provide patient history when a patient isn’t able to provide complete or reliable medical history.

Typically, you would spend 50 minutes face-to-face with the patient and independent historian to perform the following elements during the cognitive assessment:

  • Examine the patient with a focus on observing cognition
  • Record and review the patient’s history, reports, and records
  • Conduct a functional assessment of Basic and Instrumental Activities of Daily Living, including decision-making capacity
  • Use standardized instruments for the staging of dementia-like the Functional Assessment Staging Test (FAST) and Clinical Dementia Rating (CDR)
  • Reconcile and review for high-risk medications, if applicable
  • Use standardized screening instruments to evaluate for neuropsychiatric and behavioral symptoms, including depression and anxiety
  • Conduct a safety evaluation for home and motor vehicle operation
  • Identify social supports including how much caregivers know and are willing to provide care
  • Address Advance Care Planning and any palliative care needs

Cognitive Assessment and Care Planning Services:

Alzheimer’s Association Expert Task Force Recommendations and Tools for Implementation

How Do I Bill for Cognitive Assessment & Care Plan Services?

  • Initial AWV – Code G0438
    • You’re required to check for cognitive impairment as part of the AWV.
  • Subsequent AWVs – Code G0439
    • You’re required to check for cognitive impairment as part of subsequent AWVs.
  • Assessment of and care planning for patients with a cognitive impairment like dementia, including Alzheimer’s disease, at any stage of impairment – CPT code 99483 (replaced the interim HCPCS code G0505)
    • If you detect a cognitive impairment during the AWV or other routine visit, you may perform a more detailed cognitive assessment and care plan.
    • Part B coinsurance and deductible apply.
    • You may bill this code separately from the AWV. If you choose to perform the AWV and the Cognitive Assessment & Care Plan Services in the same visit, add modifier 25 to the claim.
  • Includes Level 5 E/M service CPT code 99215 elements like:
      • comprehensive history
      • comprehensive exam,
      • high complexity medical decision-making
  • Providers can’t bill CPT code 99483 on the same day as these services:
      • 90785 (Psytx complex interactive),
      • 90791 (Psych diagnostic evaluation)
      • 90792 (Psych diag eval w/med srvcs)
      • 96103 (Psycho testing admin by comp)
      • 96120 (Neuropsych tst admin w/comp)
      • 96127 (Brief emotional/behav assmt)
      • 99201– 99215 (Office/outpatient visits)
      • 99324–99337 (Domicil/r-home visits new pat)
      • 99341–99350 (Home visits)
      • 99366–99368 (Team conf w/pat by hc prof)
      • 99497 (Advncd care plan 30 min)
      • 99498 (Advncd care plan addl 30 min)

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