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, 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

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:
  • 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)
  • 96127 (Brief emotional/behav assmt)
  • 96146 (Psych/Neuropsych testing)
  • 96160 - 96161 (Admin of patient or caregiver risk assessmt)
  • 99202 - 99215 (Office/outpatient visits)
  • 99241 - 99245 (Office consultation)
  • 99324 - 99337 (Domicil/r-home visits new pat)
  • 99341 - 99350 (Home visits)
  • 99366 - 99368 (Team conf w/pat by hc prof)
  • 99497 (Advanced care plan 30 min)
  • 99498 (Advanced care plan addl 30 min)
  • 99605 - 99607 (Med mgmt. by a pharmacist)

 

Resources

 

Last Updated Tue, 22 Feb 2022 19:29:05 +0000