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Cognitive Assessment & Care Plan - Provider's Education

The CMS to conduct provider outreach and education for the Medicare-covered Cognitive Assessment & Care Plan Services for CPT code 99483 to increase awareness of this service and its eligibility requirements.

The CMC sending education document, including a direct mailing, from the Medicare Administrative Contractors (MACs) to eligible clinicians. 

For about Medicare-covered Cognitive Assessment & Care Plan Services. The education and mailing will raise general awareness of the benefit and provide information on eligibility and billing.

Eligible Providers

  • Physicians, 
  • Nurse practitioners, 
  • Clinical nurse specialists, 
  • Certified nurse-midwives
  • Physician assistants

Eligible Patients

  • All beneficiaries who are cognitively impaired are eligible to receive the services under the code. 
  • This includes those who have been diagnosed with Alzheimer’s, other dementias, or mild cognitive impairment. But, it also includes those individuals without a clinical diagnosis who, in the judgment of the clinician, are cognitively impaired.

Evaluation and Management services

  • If a physician, or other clinicians eligible to bill Evaluation and Management services, finds a patient shows signs of cognitive impairment during a routine visit.
  • Medicare covers a separate visit to more thoroughly assess the patient’s cognitive function and develops a care plan. 
  • 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.
Effective January 1, 2021, Medicare increased payment for these services, added these services to the definition of primary care services in the Medicare Shared Savings Program, and permanently allowed these services to be provided via telehealth.

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