Cognitive Assessment and Care Plan Services CPT Code 99483
Effective 1/1/2021, Medicare increased payment for these services to $282 (may be 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.
If a patient shows signs of cognitive impairment during a routine visit, Medicare allows for a more thorough assessment of the patient’s cognitive function and development of a care plan. Use CPT code 99483 to bill for both in-person and telehealth services.
Table of Contents
- How to Get Started
- Who Can Offer a Cognitive Assessment?
- Where Can a Cognitive Assessment Be Performed?
- What Is Included in a Cognitive Assessment?
- What Care Plan Services Result from the Assessment?
- How to Bill for Cognitive Assessment and Care Plan Services
- Common Questions
- Resources
How to Get Started
Detecting cognitive impairment is a required element of Medicare’s E/M services can offer this service, which include:
- Physicians (MD and DO)
- Nurse practitioners
- Clinical nurse specialists
- Physician assistants
Who Can Offer a Cognitive Assessment?
A practitioner eligible to report E/M services can offer this service, which include:
- Physicians (MD and DO)
- Nurse practitioners
- Clinical nurse specialists
- Physician assistants
Where Can a Cognitive Assessment Be Performed?
A cognitive assessment can be performed at any of these locations:
- Office or outpatient setting
- Private residence
- Care facility
- Rest home
- Via telehealth
What Is Included in a Cognitive Assessment?
The cognitive assessment includes a detailed history and patient exam. An independent historian must be present for assessments and when providing corresponding care plans under CPT code 99483.
An independent historian can be a parent, spouse, guardian, or other individual who provides the history when a patient is not able to provide complete or reliable medical history themselves. Typically, a practitioner would spend 60 minutes face-to-face with the patient and independent historian to perform the following 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 staging of dementia like the FAST and 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.
What Care Plan Services Result from the Assessment?
The information gathered during a cognitive assessment will help with the creation of a written care plan. The care plan includes initial plans to address:
- neuropsychiatric symptoms,
- neurocognitive symptoms,
- functional limitations and
- referral to community resources as needed (for example, rehabilitation services, adult day programs, support groups).
How to Bill for Cognitive Assessment and Care Plan Services
Service: Initial AWV
Code: G0438
- Practitioners are required to check for cognitive impairment as part of the AWV.
Service: Subsequent AWVs
Code: G0439
- Practitioners are required to check for cognitive impairment as part of subsequent AWVs.
Service: Assessment of and care planning for patients with cognitive impairment like dementia, including Alzheimer’s disease, at any stage of impairment
Code: 99483 (replaced the interim code G0505)
- If a cognitive impairment is detected during the AWV or other routine visit, a more detailed cognitive assessment and care plan may be performed.
- Part B coinsurance and deductible apply.
- This code may be billed separately from the AWV. Includes level 5 E/M service code 99215 elements like:
- Comprehensive history
- Comprehensive exam
- High complexity medical decision-making
Common Questions
- If my patient shows signs of cognitive impairment during an AWV or routine visit, can a cognitive assessment be performed at that time to more thoroughly assess the patient’s cognitive function and develop a care plan?
Answer: If the practitioner performs an AWV (code G0438 or G0439) or routine E/M and a cognitive assessment (99483) in the same visit, modifier 25 should be added to the claim.
- Who can perform and bill for a cognitive assessment?
Answer: The billing practitioner must perform this service. Eligible providers include physicians (MD and DO), nurse practitioners, clinical nurse specialists and physician assistants.
- In what locations can the cognitive assessment be performed?
Answer: This service can be provided in office/outpatient setting, private residence, and care facility/rest home or via telehealth. Telehealth requires both audio and video. An independent historian must be present with the patient during the assessment.
- Does Medicare have a set definition as to who qualifies as an independent historian?
Answer: An independent historian can be family, friends, caregivers, and other individuals who provide the history when a patient is unable to provide complete or reliable medical history themselves.
- Is there a typical length of time for a cognitive assessment?
Answer: Typically, the amount of face-to-face time spent is 60 minutes with the patient and independent historian to perform the cognitive assessment.
Resources
- National Institute on Aging Alzheimer’s and Dementia Resources for Professionals web page for more information on assessing cognitive impairment.
- CY 2018 Physicians Fee Schedule Final Rule (82 FR 53077) replaced G0505 with CPT code 99483.
- CY 2021 Physician Fee Schedule Final Rule (85 FR 84472) modified CPT code 99483 by adding it as a permanent telehealth service, increasing its valuation, and defining it as a primary care service in the Medicare Shared Savings Program.
- MLN® Educational Tool Medicare Wellness Visits for more information about AWVs.
Reviewed 10/10/2023