If your patient shows signs of cognitive impairment during a routine visit, Medicare covers a separate visit to more thoroughly assess your patient’s cognitive function and develop a care plan. This fact sheet educates providers on Medicare coverage requirements and billing standards for assessment of, and care planning for, patients with cognitive impairment (CPT code 99483).

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. Use CPT code 99483 to bill for both in-person and telehealth services.

How Do I Get Started?

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. This additional evaluation is necessary 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.

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
• Physician assistants

What’s Included in a Cognitive Assessment?

The cognitive assessment includes a detailed history and patient exam. An independent historian must be present for assessments and when you provide corresponding care plans under CPT code 99483.

An independent historian can be a parent, spouse, guardian, or other individual who provides the history
when a patient isn’t able to provide complete or reliable medical history themselves. Typically, you would
spend 50 minutes face-to-face with the patient and independent historian to perform the following 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

What Care Plan Services Result from the Assessment?

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

How Do I Bill for Cognitive Assessment & Care Plan Services?

Resources

• Alzheimer’s and Dementia Resources for Professionals webpage for more information on assessing cognitive impairment https://www.nia.nih.gov/health/alzheimers-dementia-resources-for-professionals
• CY 2018 Physician Fee Schedule final rule (82 FR 53077) replaced G0505 with CPT code 99483 https://www.govinfo.gov/content/pkg/FR-2017-11-15/pdf/2017-23953.pdf#page=102
• CY 2021 Physician Fee Schedule final rule (85 FR 84472) modified CPT code 99483 by adding it as a permanent telehealth service, increasing its valuation, and defining it as a primary care service in the Medicare Shared Savings Program https://www.govinfo.gov/content/pkg/FR-2020-12-28/pdf/2020-26815. pdf#page=278
• Medicare Wellness Visits educational tool for more information about AWV’s https://www.cms.gov/ Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/preventive-services/medicarewellness-visits.html

Medicare Learning Network® Content Disclaimer, Product Disclaimer, and Department of Health & Human Services Disclosure

This educational product was current at the time it was published or uploaded onto the web. Medicare policy changes frequently so links to the source documents have been provided within the document for your reference.

This educational product was prepared as a service to the public and is not intended to grant rights or impose obligations. This educational product may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations, and other interpretive materials for a full and accurate statement of their contents.

Paid for by the Department of Health & Human Services