January 1, 2017, onwards Medicare provided coverage for cognitive assessment and care plan services. Reimbursement requires cognition-focused evaluation, identification of caregivers and caregiver needs, and development, revision, or review of an Advance Care Plan.
Effective January 1, 2022, Medicare increased payment for these services to $282 (it will get 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. Use CPT code 99483 to bill for both in-person and telehealth services.
Detecting cognitive impairment is a required element of Medicare’s Annual Wellness Visit (AWV). You can also detect cognitive impairment as part of a routine visit through direct observation or by considering information from the patient, family, friends, caregivers, and others. You may also use a brief cognitive test and evaluate health disparities, chronic conditions, and other factors that contribute to increased risk of cognitive impairment.
If you detect cognitive impairment at an AWV or other routine visit, you may perform a more detailed cognitive assessment and develop a care plan during a separate visit. This additional evaluation may be helpful to diagnose a person with dementia, such as Alzheimer’s disease, and to identify treatable causes or co-occurring conditions such as depression or anxiety.
Billing for Cognitive Assessment and Care Plan
Who can offer a cognitive assessment? 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; and Physician assistants.
Where to perform the cognitive assessment? Providers can perform the assessment at any of these locations: Office or outpatient setting; Private residence; Care facility; Rest home, and Via telehealth.
Care plan: Providers will use information gathered during a cognitive assessment to help them create 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) shared with the patient or caregiver with initial education and support.
CPT G0438 (Initial AWV): Providers are required to check for cognitive impairment as part of the AWV.
CPT G0439 (Subsequent AWVs): Providers are required to check for cognitive impairment as part of subsequent AWVs.
CPT 99483 (Assessment of and care planning for patients with a cognitive impairment like dementia, including Alzheimer’s disease, at any stage of impairment): If providers detect a cognitive impairment during the AWV or other routine visit, they may perform a more detailed cognitive assessment and care plan. Please note that CPT code 99483 replaced the interim HCPCS code G0505.
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. Part B coinsurance and deductible apply. It includes Level 5 E/M service CPT code 99215 elements like Comprehensive history; Comprehensive exam; and High complexity medical decision-making.
As of January 1, 2022, Medicare pays approximately $283 (maybe geographically adjusted) for these services when provided in an office setting.
You will require a good understanding of the above-mentioned billing guidelines for your cognitive assessment claims to get paid accurately. Plus, your documentation must be appropriate to validate medical necessity.
If you need any help in outsourcing medical billing and coding then Medical Billers and Coders (MBC) can assist you. Our team has a good understanding of billing guidelines of cognitive assessment for Medicare and other private providers. To know more about our cognitive assessment billing services, contact us at info@medicalbillersandcoders.com / 888-357-3226
FAQs:
Medicare covers cognitive assessment and care plan services, including evaluation of cognitive impairment, identification of caregiver needs, and development of an Advance Care Plan.
Providers should use CPT code 99483 to bill for both in-person and telehealth cognitive assessment and care planning services.
Any clinician eligible to report evaluation and management (E/M) services can perform cognitive assessments, including MDs, DOs, nurse practitioners, clinical nurse specialists, and physician assistants.
Cognitive assessments can be conducted in various settings, including office or outpatient environments, private residences, care facilities, and via telehealth.
As of January 1, 2022, Medicare reimburses approximately $282 for cognitive assessment services provided in an office setting, with potential geographic adjustments, and requires proper documentation for claims.
