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Cognitive Assessment and Care Plan - Guidelines

Cognitive assessment and care plan services are provided when a comprehensive evaluation of a new or existing patient, who exhibits signs and/or symptoms of cognitive impairment, is required to establish or confirm a diagnosis, etiology, and severity for the condition.

Do not report cognitive assessment and care plan services if any of the required elements are not performed or are deemed unnecessary for the patient’s condition

A single physician or other qualified health care professional should not report 99483 more than once every 180 days.

CPT code 99483 provides reimbursement to physicians and other eligible billing practitioners for a comprehensive clinical visit that results in a written care plan

Eligible Provider

Any provider is eligible to report E/M services can provide this service. Eligible providers include physicians MD and DO, nurse practitioners, clinical nurse specialists, and physician assistants

Eligible practitioners must provide documentation that supports a moderate-to-high level of complexity in medical decision making, as defined by E/M guidelines.

The provider must also document the detailed care plan developed as a result of each required element covered by 99483

Required Elements to bill CPT 99483

CPT 99483 - Assessment of and care planning for a patient with cognitive impairment, requiring an independent historian, in the office or other outpatient, home or domiciliary or rest home, with all of the following required elements,
  • Cognition-focused evaluation including a pertinent history and examination.
  • Medical decision-making of moderate or high complexity.
  • Functional assessment (eg, basic and instrumental activities of daily living), including decision-making capacity.
  • Use of standardized instruments for the staging of dementia (eg, functional assessment staging test [FAST], clinical dementia rating [CDR]).
  • Medication reconciliation and review for high-risk medications.
  • Evaluation for neuropsychiatric and behavioral symptoms, including depression, including use of standardized screening instrument(s).
  • Evaluation of safety (eg, home), including motor vehicle operation.
  • Identification of caregiver(s), caregiver knowledge, caregiver needs, social supports, and the willingness of caregiver to take on caregiving tasks.
  • Development, updating or revision, or review of an Advance Care Plan.
  • Creation of a written care plan, including initial plans to address any neuropsychiatric symptoms, neurocognitive symptoms, functional limitations, and referral to community resources as needed (eg, rehabilitation services, adult day programs, support groups) shared with the patient and/or caregiver with initial education and support.
  • Typically, 50 minutes are spent face-to-face with the patient and/or family or caregiver.
Many of the required assessment elements can be completed by appropriately trained members of the clinical team working with the eligible provider. 

Assessments that require the direct participation of a knowledgeable care partner or caregivers, such as a structured assessment of the patient’s functioning at home or a caregiver stress measure, may be completed prior to the clinical visit and provided to the clinician for inclusion in care planning. 

Care planning visits can be conducted in the office or other outpatient, home, domiciliary, or rest home settings.

Qualified health care professionals may report 99483 as frequently as once per 180 days

Tips

Do not report 99483 in conjunction with the following CPT codes,
  • E/M services - 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99241, 99242, 99243, 99244, 99245, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99366, 99367, 99368, 99497, 99498.
  • Psychiatric diagnostic procedures 90785, 90791, 90792.
  • Brief emotional/behavioral assessment - 96127.
  • Psychological or neuropsychological test administration 96146. 
  • Health risk assessment administration 96160, 96161.
  • Medication therapy management services 99605, 99606, 99607.

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