Current Procedural Terminology (CPT) code 99483 reimburses physicians and other qualified health care professionals for cognitive assessment and care planning for patients with cognitive impairment, including dementia and Alzheimer's disease, at any stage of impairment.
According to the Alzheimer’s Association, approximately 1 in 9 people (10.9%) in the U.S. age 65 and older has Alzheimer’s dementia. However, there’s a significant gap in diagnosis and treatment. Only 40% of individuals in the U.S. with dementia have been formally diagnosed.
This represents a significant opportunity for healthcare providers to improve dementia detection and serve a growing patient population with rising demand for dementia care. Fortunately, there’s an emergence of more sensitive tools for detecting mild cognitive impairment earlier, such as the Creyos MCI screen and cognitive care plan.
By addressing this gap in care, healthcare providers can improve detection, diagnosis, and care planning, improving patient health outcomes while tapping into a source of revenue and reimbursement for their practices.
Below, we’ll cover how to meet the requirements of CPT code 99483 for cognitive care planning and introduce the Creyos Dementia Protocol and Cognitive Care Plan, which includes a screener for cognitive impairment and built-in care planning tools.
Article Highlights
CPT code 99483 covers cognitive assessment and care planning for patients with cognitive impairment, including dementia and Alzheimer's disease, at any stage.
According to the Centers for Medicare & Medicaid Services (CMS), CPT Code 99483 provides reimbursement for physicians and other eligible billing practitioners regarding the “assessment of and care planning for patients with cognitive impairment like dementia, including Alzheimer’s disease, at any stage of impairment.” Code 99483 replaced the interim Healthcare Common Procedure Coding System (HCPCS) code G0505 in January 2018.
CPT code 99483 includes six service elements:
See the American Medical Association (AMA) CPT 2018 manual for full details.
Typically a physician will communicate the contents of a care plan with patients and their caregivers. However, the following qualified health care professionals can bill for code 99483 after meeting the assessment requirements.
Examples from CMS include:
As per the CMS regulations, a single physician or other qualified health care professional should not report 99483 more than once every 180 days. After this time period has elapsed, a physician may bill again for the same patient.
The standard Medicare reimbursement rate for cognitive care planning is approximately $260.
As a best practice, healthcare providers should check with a patient’s insurance carrier to ensure their plan provides coverage for cognitive care planning services. Payer coverage varies across public and private payers, and varies by U.S. state.
The best way to select the appropriate billing codes for your practice is to speak with certified professional coders and your local payers before billing.
Per Medicare regulations, if you detect a cognitive impairment during the annual wellness visit (AWV), or other routine visit, you may perform a more detailed cognitive assessment and care plan. You may bill this code separately from the AWV. CPT code 99483 includes Level 5 evaluation and management (E/M) service CPT code 99215 elements like:
Providers can use CPT code 99483 with HCPCS code G2212 for a visit that exceeds the 60-minute timeframe.
Providers cannot bill CPT code 99483 on the same day as these services:
| Code | Service |
|---|---|
| 90785 | Psychological complex interactive |
| 90791 | Psychological diagnostic evaluation |
| 90792 | Psychological diagnostic evaluation with medical services |
| 96103 | Psychological testing an administrator |
| 96120 | Neuropsychological testing by an administrator |
| 96127 | Brief emotional / behavioral assessment |
| 99201–99215 | Office outpatient visits |
| 99324–99337 | Home visits with new patients |
| 99341–99350 | Home visits |
| 99366–99368 | Medical team conference |
| 99497 | Advanced care plan, first 30 minutes |
| 99498 | Advanced care plan, additional 30 minutes |
CMS lists the following required elements for CPT code 99483:
Healthcare providers should keep in mind these additional requirements:
A cognitive care plan can be completed in one or more visits and is relevant to new or existing patients. Finally, the care plan can be conducted in the clinic, with an outpatient, an at-home visit, or via telehealth.
For more details on specific modifiers and billing scenarios, please visit the CMS cognitive assessment and care plan services page.
When dealing with mild cognitive impairment or dementia, clear and actionable communication is crucial. The best practices for documenting and communicating a written cognitive care plan include the following:
Typically, physicians use standard cognitive assessment tools such as the Mini-Cog, the Mini-Mental State Examination (MMSE), or the Montreal Cognitive Assessment (MoCA) to determine if a patient has cognitive impairment. Unfortunately, these standard tests lack the sensitivity to detect mild cognitive impairment in its early stages, and often only measure more severe dementia.
Computerized cognitive assessments are starting to close this gap and provide tools for earlier dementia detection. The Creyos Dementia Screen detected 16 potential impairments out of a group of 50 tested participants, compared to the 1 detected by the MMSE. That 32% is directly in line with the percentage of the overall population above 65 that may suffer from a cognitive impairment of any kind, including earlier impairments such as MCIs.
We created the Creyos Cognitive Care Plan with CPT 99483 reimbursement requirements in mind. It involves a screener for detecting early signs of cognitive impairment and cognitive care planning for patients with confirmed dementia.
Completing the care plan flow ensures that you include all the information required by the CPT code 99483 in the care plan report (this includes the completion checklist). The information should be collected during a 50-minute in-person care plan visit with the patient and their caregiver.
The Creyos Cognitive Care Plan is aligned with recommendations from the Alzheimer's Association, and caters to individuals with cognitive conditions, addressing medical, therapeutic, and lifestyle needs for enhanced well-being. It’s designed to enhance the quality of life for patients with severe cognitive disorders and provides caregivers with essential information for daily management.
Our cognitive care plan was designed with CPT code 99483 requirements in mind, providing comprehensive documentation compliant with most payers billing requirements. Remember to always check with payers to ensure your practice qualifies for reimbursement.
Creyos Health can play a key role in making billing easy, such as:
Please note that Creyos Health can not determine your eligibility for reimbursement and does not assume responsibility over the outcome of any claims. Use of the following CPT codes will depend on services provided, procedures, associated CCI edits, and other factors.
Please contact your local payer to determine whether you qualify for the codes we outline below, as well as for any additional coding and coverage guidelines, services, limits on billable time, and required/allowed modifier uses.
The information contained in this document is provided to help you understand the reimbursement process. It is not intended to increase or maximize reimbursement by any payer. We strongly suggest that providers consult their payer organizations with regard to local reimbursement policies.
The information contained in this document is provided for informational purposes only and represents no statement, promise or guarantee by Creyos (formerly Cambridge Brain Sciences) concerning levels of reimbursement, payment or charge. Similarly, all CPT®, HCPCS Level II® and ICD-10-CM codes are supplied for informational purposes only and represent no statement, promise or guarantee by Creyos that these codes will be appropriate or that reimbursement will be made.
Written by Emily Montemayor, Medical Coding Support Manager
Emily has 10+ years of experience in healthcare, holding CCS, CMBCS, COC, CPC, and CPMA credentials. She has trained and supported 50+ hospitals across the U.S. and internationally, focusing on compliance, optimized reimbursement, and improved coding and auditing practices.