CPT Code 99483: How to Bill Through Cognitive Care Planning

Addressing the Gap in Dementia Care

Among cognitive impairment cases, the prevalence of Alzheimer’s dementia in the U.S. is alarming. The Alzheimer’s Association reports that 10.9% of Americans aged 65 and older have Alzheimer’s dementia. Despite this high prevalence, only 40% of individuals with dementia receive a formal diagnosis. This gap presents a crucial opportunity for healthcare providers to enhance dementia detection and care while accessing a valuable reimbursement source through cognitive care planning. Fortunately, CPT Code 99483 also covers a wide range of cognitive impairment cases, such as Mild Cognitive Impairment (MCI), and cognitive impairment due to other medical conditions.

This article explains how to use CPT Code 99483 to bill cognitive care planning services and introduces Advanta’s MyPlan AI Care Planning. This includes integrated care planning tools to help healthcare providers improve patient outcomes while ensuring proper billing and reimbursement.

Defining CPT Code 99483

CPT Code 99483 provides reimbursement for the assessment and care planning of patients with cognitive impairment, including dementia and Alzheimer’s disease. Introduced in 2018 to replace the interim HCPCS code G0505, this code covers various components essential to cognitive care planning, including:

• Cognitive, functional, and safety assessments

• Evaluation of neuropsychiatric and behavioral symptoms

• Medication review

• Caregiver needs assessment

• Comprehensive clinical visit

• Complete written care plan

Who Can Bill for CPT Code 99483?

CPT Code 99483 can be billed by the following qualified healthcare professionals who meet the required assessment standards:

• Physicians

• Nurse practitioners

• Clinical nurse specialists

• Physician assistants

Frequency of Use for CPT Code 99483

According to CMS regulations, CPT Code 99483 can be billed once every 180 days per patient by a single physician or qualified healthcare professional. After this period, the code can be used again for the same patient if needed.

Reimbursement Value of CPT 99483 in 2024

In 2024, the standard Medicare reimbursement rate for CPT Code 99483 is approximately $260. However, healthcare providers should verify coverage with individual patients’ insurance carriers, as payer coverage may vary by state and between public and private payers.

Billing Multiple Codes: Related CPT Codes

When billing for cognitive care planning, consulting with certified professional coders and local payers is essential. A detailed cognitive assessment and care plan can be billed separately if cognitive impairment is detected during an annual wellness visit (AWV) or routine checkup. CPT Code 99483 includes elements of a Level 5 E/M service, such as:

• Comprehensive history and exam

• High-complexity medical decision-making

CPT Code 99483 can be combined with HCPCS code G2212 for visits exceeding 60 minutes but cannot be billed on the same day as specific other services (e.g., psychological evaluations, home visits, advanced care planning).

Requirements for CPT Code 99483 Reimbursement

Advanta’s MyPlan AI Care Planning was designed to meet the specific requirements of CPT Code 99483, ensuring that all necessary information is included in the care plan report. Key requirements include:

• Comprehensive patient history and functional evaluation

• Use of standardized instruments to assess dementia stage

• Medication review and reconciliation

• Assessment of neuropsychiatric symptoms and safety risks

• Caregiver identification and assessment

• Education on social services and support resources

• Advance Care Planning and Palliative Care Considerations

Providers must also demonstrate the medical necessity of the care plan, ensuring that it involves moderate to high complexity in medical decision-making.

Documenting and Communicating a Cognitive Care Plan

Clear communication and thorough documentation are vital when managing cognitive impairment. Best practices for documenting and communicating a cognitive care plan include:

• Conducting an in-person visit to explain the care plan

• Providing a clear record with details on medical necessity, cognitive tasks, and mental health symptoms

• Writing in accessible language for patients and caregivers

• Clearly outlining responsibilities for the patient and caregiver

Detecting Cognitive Impairment for Cognitive Care Planning

Standard cognitive assessments like the Mini-Cog, MMSE, or MoCA often miss early signs of mild cognitive impairment (MCI). Our computerized assessments are closing this gap by detecting impairments earlier and more accurately.

How Advanta’s MyPlan Supports Billing and Care Planning

MyPlan is an AI-powered care plan builder designed to streamline your workflow, enhance patient care, and drive revenue. By leveraging advanced analytics and clinical expertise, MyPlan generates personalized, actionable care plans that address complex patient needs.

Streamlined Care Planning

• Efficient Workflow: MyPlan’s intuitive interface allows for rapid care plan creation and management, saving you time and effort.

• Personalized Care: Our AI-driven algorithms analyze patient data to develop tailored care plans, ensuring optimal patient outcomes.

• Data Management: Easily store, access, and reference patient information to inform care decisions and track progress.

Enhanced Patient Care

• Comprehensive Assessments: MyPlan supports multiple mental health screenings and care plans, helping you identify and address patient needs effectively.

• Improved Outcomes: MyPlan helps improve patient outcomes and satisfaction by providing personalized care plans.

• Addressing Unmet Needs: MyPlan addresses the growing need for cognitive care planning, empowering you to provide essential services to your patients.

Revenue Generation

• Billing Support: MyPlan is fully compliant with CMS billing requirements for CPT 99483, allowing you to generate additional revenue.

• Increased Profitability: Our data shows that practices using MyPlan can significantly increase monthly revenue through cognitive care plan billing.

By combining advanced technology with clinical expertise, MyPlan empowers healthcare providers to deliver exceptional patient care while maximizing efficiency and revenue.

Ready to experience the MyPlan advantage? 

Start your free trial today and discover how our AI-powered care planning solution can transform your practice.

Questions and Comments:

Healthcare providers’ experiences with billing for neuropsychological evaluations and cognitive tests can vary. We encourage you to share your experiences, whether they align with this article or differ. Feel free to reach out to discuss reimbursement strategies.

Legal Notice

This document provides information to help understand the reimbursement process and is not intended to maximize reimbursement from any payer. Providers should consult with payers regarding local reimbursement policies.

Advanta does not guarantee reimbursement, and all CPT®, HCPCS Level II®, and ICD-10-CM codes are provided for informational purposes only.

Optimize Your Cognitive Care and Revenue with Advanta Biometrics

By effectively implementing cognitive care planning and utilizing CPT Code 99483, healthcare providers can significantly improve the care of patients with dementia while generating additional revenue.** Advanta’s MyPlan offers a comprehensive solution to streamline the process, from initial assessment to care plan development and billing. With a focus on early detection, personalized care, and efficient documentation, healthcare providers can make a substantial impact on the lives of patients with dementia and their families. Ready to optimize your dementia care and increase your revenue? Schedule a free consultation with our experts to learn how MyPlan can benefit your practice.