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, 2021 - Payment was increased to $282 (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

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