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How to Bill Using CPT Code 99483 for Cognitive Care Planning

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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 service 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 those available in Creyos Health.

By addressing this gap in care, healthcare providers can improve detection, diagnosis, 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.

Disclaimer

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.

Defining CPT Code 99483

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 HCPCS code G0505 in January 2018.

The components of CPT Code 99483 and of designing and delivering a care plan for patients with cognitive impairment requires:

  • Assessment that includes cognition, function, and safety
  • Evaluation of neuropsychiatric and behavioral symptoms
  • Review of medications
  • Assessment of the needs of the patient’s caregiver
  • A comprehensive clinical visit
  • A complete written care plan

See the CPT 2018 manual for full details.

Who Can Bill for CPT Code 99483?

Typically a physician will communicate the contents of a care plan with patients and their caregivers. However, the following qualified healthcare clinicians can bill for code 99483 after meeting the assessment requirements.

Examples include:

  • Physicians
  • Nurse practitioners
  • Clinical nurse specialists
  • Physician assistants

How Often Can CPT Code 99483 Be Used?

As per the CMS regulations, a single physician or other qualified healthcare 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.

What is the Reimbursement Value of CPT 99483 in 2024?

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.

Related CPT Codes: How Do I Bill Multiple Codes?

The best way to select the codes that are most applicable to your practice is by speaking to certified professional coders and your local payers ahead of 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. Providers can use CPT code 99483 with HCPCS code G2212 for a visit that exceeds the 60-minute timeframe. You may bill this code separately from the AWV. CPT code 99483 includes Level 5 E/M service CPT code 99215 elements like:

  • Comprehensive history
  • Comprehensive exam
  • High complexity medical decision-making

Providers cannot bill CPT code 99483 on the same day as these services:

  • 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

Meeting CPT Code 99483 Reimbursement Requirements

In Creyos, physicians can administer assessments for mild cognitive impairment. These computerized tests were designed to align with the best practices for capturing accurate patient data and providing detailed, easy-to-interpret reports—streamlining existing reimbursement and billing workflows.

The following information should be collected during a 50-minute in-person appointment with the patient and their caregiver.

For a breakdown of the code requirements, refer to the following list by CMS:

  • Document and assess the patient's history, reports, and records
  • Perform a functional evaluation of Basic and Instrumental Activities of Daily Living, as well as an assessment of decision-making capacity
  • Employ standardized instruments to determine the stage of dementia
  • Review and reconcile medications, flagging any high-risk prescriptions as needed
  • Utilize standardized screening tools to evaluate neuropsychiatric and behavioral symptoms, including depression and anxiety
  • Conduct a safety assessment for home and motor vehicle operation
  • Identify the caregiver, assess their understanding of the condition, and determine their willingness to provide care
  • Educate the patient and caregiver about social services, at-home care, and support groups
  • Address Advance Care Planning and attend to palliative care needs

Healthcare providers should keep in mind these additional requirements:

  • Spend 50 minutes with patient and caregiver to communicate contents of the care plan
  • Determine medical necessity (e.g. patient shows signs of cognitive impairment)
  • Demonstrate that the case involves a moderate to high level of complexity in medical decision making

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 cms.gov.

Documenting and Communicating a Written Care Plan

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:

  • Use an in-person visit to walk through the contents of the care plan with a patient and caregiver to be available to answer any questions and provide additional resources.
  • Provide a complete record with explanation about medical necessity, summary of the cognitive tasks administered, description of cognitive disorder and mental health symptoms
  • Write the report in a clear, accessible language for patient and caregiver
  • Outline clearly who is responsible for carrying out recommended steps in an easy to follow way for the patient and caregiver

Detecting Cognitive Impairment to Determine the Need for a Cognitive Care Plan

Typically, physicians use standard cognitive assessments such as the Mini-Cog, MMSE, or the 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 such as those offered in Creyos are starting to close this gap and provide tools for earlier dementia detection.

How Creyos Helps

Creyos Health can play a key role in making billing easy, such as:

  • Delivering a comprehensive report that documents assessment results, date of administration, patient details, etc
  • Generating easy-to-read reports that aid in interpretation of standardized results, interactive feedback with the patient, clinical decision making, and treatment planning
  • Seamless documentation (and full integration, in some cases) within an EHR for record-keeping and future reference
  • Complementing other assessment results in order to aid in diagnosis, thereby proving medical necessity for other services that may be billed during the same session or at a later date
  • Combining mental health assessments for depression, anxiety, and ADHD in the same platform as cognitive assessments, so that mental health questionnaires can justify the need for cognitive testing, and vice versa, with a single email to a patient

Questions or Comments?

Healthcare providers can have different experiences with billing for neuropsychological evaluations, cognitive tests, and related services. We would greatly appreciate it if you could share any of your experience, whether consistent with this article or you had to take different steps. Reach out any time to discuss reimbursement.

Legal

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.

References


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