Submitted by Julie Eagan on

Cognitive Assessment & Care Plan Services - CPT 99483 [last edit 1-30-2022]

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 – use CPT code 99483 to bill for this service. 

What’s Included in a Cognitive Assessment? 
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. An independent historian can be a parent, spouse, guardian, or other individual who provides patient history when a patient isn’t able to provide complete or reliable medical history. 

Typically, you would spend 50 minutes face-to-face with the patient and independent historian to perform the following elements 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 

TCM Services Requirements [last edit 1-30-2022]

 

The 30-day TCM period begins on a patient’s inpatient discharge date and continues for the next 29 days ("inpatient"; "SNF"; not ED, not urgent care). ​

TCM services begin the day of discharge from 1 of these inpatient or partial hospitalization settings:

  • Inpatient Acute Care Hospital
  • Inpatient Psychiatric Hospital
  • Long-Term Care Hospital
  • Skilled Nursing Facility
  • Inpatient Rehabilitation Facility
  • Hospital outpatient observation or partial hospitalization
  • Partial hospitalization at a Community Mental Health Center ​

After inpatient discharge, the patient must return to their community setting. ​

These could include:

  • Home
  • Domiciliary
  • Nursing home
  • Assisted living facility​

99495 (visit in 14 days)/99496 (visit in 7 days):

  • Communication (direct contact, telephone, electronic) with the patient and /or caregiver within 2 business days of discharge
  • Medical decision making of at least moderate complexity during the service period
  • Face-to-face visit, within 14 or 7 calendar days of discharge (depends on visit and timing from discharge)

Reference https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Transitional-Care-Management-Services-Fact-Sheet-ICN908628.pdf