Cognitive Assessment and Care Plan (CACP) - JE Part B
Cognitive Assessment and Care Plan (CACP)
If you see signs and or symptoms, indicating cognitive concerns, in your patient during an Annual Wellness Visit (AWV), Initial Preventive Physical Exam (IPPE), or any Evaluation and Management Exam (E&M) there is an additional visit they may qualify for - 99483.
January 1, 2023 - Payment is now $286 (before geographical adjustment) for 99483 when performed in an office setting.
- Added these services to definition of primary care services in Medicare Shared Savings Program
- Permanently covered via telehealth (same CPT code)
Eligible Providers
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
Place of Service
You can perform the assessment at any of these locations:
- Office or outpatient setting
- Private residence
- Care facility
- Rest home
- Via telehealth
Components
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 individual who provides 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 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
Written Care Plan Creation
You'll use information gathered during a cognitive assessment to help you create a written care plan. The care plan includes initial plans to address:
- Neuropsychiatric symptoms
- Neurocognitive symptoms
- Functional limitations
- Referral to community resources as needed (for example, rehabilitation services, adult day programs, support groups) shared with the patient or caregiver with initial education and support
Billing
| Service | Code | Things to Know |
|---|---|---|
| Initial AWV | G0438 | You're required to check for cognitive impairment as part of the AWV. |
| Subsequent AWV | G0439 | You're required to check for cognitive impairment as part of subsequent AWVs. |
| Assessment of and care planning for patients with 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 elements like:
|
Resources
- CMS Cognitive Assessment & Care Plan Services
- CMS YouTube video Medicare Coverage and Payment of Cognitive Assessment & Care Plan Services
- CMS Cognitive Assessment Provider Letter for Posting
- National Institute on Aging Alzheimer's and Related Dementia Resources for Professionals
- CMS Report to Congress for CACP Provider Outreach Campaign
