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Article from CMS/OPOLE: Cognitive Assessment and Care Plan Services

Posted 3 months ago

Medicare Increases Payment for Cognitive Care

Alzheimer’s dementia affects one in nine people age 65 and older and kills more than breast and prostate cancer combined.  The Centers for Medicare & Medicaid Services has taken steps to address this public health crisis by increasing payment for and expanding access to cognitive assessment and care plan services.

Effective January 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.

 

4 Things to Know About the Cognitive Assessment & Care Plan Services

  1. If your patient shows signs of cognitive impairment at an Annual Wellness Visit (AWV) or other routine visit, you may perform a more detailed cognitive assessment and develop a care plan
  2. The Cognitive Assessment & Care Plan Services (CPT code 99483) typically start with a 50-minute face-to-face visit that includes a detailed history and patient exam, resulting in a written care plan
  3. If you report evaluation and management (E/M) services, you can offer this service, including: physicians (MD and DO), nurse practitioners, clinical nurse specialists, and physician assistants.
  4. Use CPT code 99483 to bill for this service. Part B coinsurance and deductible apply. You may bill this code separately from the AWV.

 

For More Information

Please review more detail on Medicare coverage requirements and billing standards at www.cms.gov/cognitive.

 

And, for more information on assessing cognitive impairment, please refer to the Alzheimer’s and Dementia Resources for Professionals webpage at https://www.nia.nih.gov/health/alzheimers-dementia-resources-for-professionals.

Dexter Glasgow

Office of Program Operations and Local Engagement

Centers for Medicare & Medicaid Services

801 Market Street Suite 9400

Philadelphia, PA 19107-3134

Phone: (215) 861-4173

Fax: (443) 380-7431