Learn how to conduct reimbursable clinical visits using Current Procedural Terminology® (CPT) Code 99483 and other commonly used billing codes, for services aimed at improving detection, diagnosis, and care planning and coordination for patients with Alzheimer’s disease and related dementia and their caregivers.
Commonly used billing codes for dementia and mild cognitive impairment
Although CPT Code 99483 is specific to evaluating and treating dementia, and should be used in the appropriate circumstances, there are other ways to be compensated for ongoing care for patients already diagnosed with cognitive impairment or dementia. Commonly used CPT codes for dementia include the following:
| Diagnostic/Procedure Codes |
Key Considerations |
G31.84 - Mild Cognitive Impairment
G30.0 - Alzheimer's Disease With Early Onset
G30.1- Alzheimer's Disease With Late Onset
G30.9 - Other Alzheimer's Disease
G30.9 - Alzheimer's Disease Unspecified
F03.90 - Unspecified Dementia Without Behavioral Disturbances
F03.91 - Unspecified Dementia With Behavioral Disturbances
F01.50 - Vascular Dementia Without Behavioral Disturbances
F01.51 - Vascular Dementia With Behavioral Disturbances
G31.83 - Dementia With Lewy Bodies
G31.09 - Frontotemporal Dementia
R41.81 - Age-related Cognitive Decline |
- 1/2 of people with dementia do not have a diagnosis.
- Highest risk factor for dementia is age (65+).
- An estimated 11% of people 65+ and 32% 85+ have dementia.
- 2/3 of people living with dementia are women.
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Diagnostic/Procedure Codes for Dementia With Behavioral Health Systems (ICD-10)
G31.83 - Dementia With Lewy Bodies
G31.09 - Frontotemporal Dementia
F03.91 - Unspecified Dementia With Behavioral Disturbances
F01.51 - Vascular Dementia With Behavioral Disturbances
F02.80 - Dementia in Other Diseases Classified Elsewhere With Behavioral Disturbances
F02.81 - Dementia in Other Diseases Classified Elsewhere With Behavioral Disturbances |
- Psychological symptoms and behavioral abnormalities in dementia are common such as depression, anxiety, psychosis, agitation, aggression, disinhibition, and sleep disturbances.
- Approximately 30% to 90% of patients with dementia suffer from behavioral symptoms.
- Nearly all community-dwelling elderly individuals with dementia will develop psychiatric symptoms within five years.
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CPT Code 99483
CPT code 99483 provides reimbursement for a clinical visit that results in a comprehensive care plan. This allows you to deliver services that can contribute to a higher quality of life for your patients.
Clinicians who can be reimbursed under this medical billing code include physicians, physician assistants, nurse practitioners, clinical nurse specialists and certified nurse midwives.
This code requires an independent historian; a multidimensional assessment that includes cognition, function and safety; evaluation of neuropsychiatric and behavioral symptoms; review and reconciliation of medications; and assessment of the needs of the patient’s caregiver. These components are central to informing, designing and delivering a care plan suitable for patients with cognitive impairment.
Who is eligible to receive this comprehensive care planning service?
Cognitive assessment and care plan services are provided when a comprehensive evaluation of a new or existing patient, who exhibits signs and/or symptoms of cognitive impairment, is required to establish or confirm a diagnosis, etiology and severity for the condition.
Who can provide this service?
Any practitioner eligible to report E/M services can provide this service. Eligible providers include physicians (MD and DO), nurse practitioners, clinical nurse specialists, and physician assistants. Eligible practitioners must provide documentation that supports a moderate-to-high level of complexity in medical decision making, as defined by E/M guidelines (with application as appropriate of the usual “incident-to” rules, consistent with other E/M services). The provider must also document the detailed care plan developed as a result of each required element covered by CPT code 99483.
What are the required elements?
Assessment of and care planning for a patient with cognitive impairment, requiring an independent historian, in the office or other outpatient, home, domiciliary or rest home setting with all of the following required elements:
- Cognition-focused evaluation including a pertinent history and examination;
- Medical decision-making of moderate or high complexity;
- Functional assessment (e.g., basic and instrumental activities of daily living), including decision-making capacity;
- Use of standardized instruments for staging of dementia (e.g., functional assessment staging test [FAST], clinical dementia rating [CDR]);
- Medication reconciliation and review for high-risk medications;
- Evaluation for neuropsychiatric and behavioral symptoms, including depression, including use of standardized screening instrument(s);
- Evaluation of safety (e.g., home), including motor vehicle operation;
- Identification of caregiver(s), caregiver knowledge, caregiver needs, social supports, and the willingness of caregiver to take on caregiving tasks;
- Development, updating or revision, or review of an Advance Care Plan;
- Creation of a written care plan, including initial plans to address any neuropsychiatric symptoms, neurocognitive symptoms, functional limitations, and referral to community resources as needed (e.g., rehabilitation services, adult day programs, support groups) shared with the patient and/or caregiver with initial education and support.
Typically, 50 minutes are spent face to face with the patient and/or family or caregiver.
How to access the required elements?
The nine assessment elements of CPT code 99483 can be evaluated within the care planning visit or in one or more visits that precede it, using appropriate billing codes (most often an E/M code). Patients with complex medical, behavioral, psychosocial and/or caregiving needs may require a series of assessment visits, while those with well-defined or less complex problems may be fully assessed during the care plan visit. Results of assessments conducted prior to the care plan visit are allowed in care planning documentation provided they remain valid or are updated with any changes at the time of care planning.
A single physician or other qualified health care professional should not report 99483 more than once every 180 days.
Many of the required assessment elements can be completed by appropriately trained members of the clinical team working with the eligible provider. Assessments that require the direct participation of a knowledgeable care partner or caregiver, such as a structured assessment of the patient’s functioning at home or a caregiver stress measure, may be completed prior to the clinical visit and provided to the clinician for inclusion in care planning. Care planning visits can be conducted in the office or other outpatient, home, domiciliary or rest home settings.
For more information
For additional details about CPT code 99483, please download our free
Cognitive Impairment Care Planning Toolkit, which includes information on:
- Measurement tools to support the care planning process and its documentation.
- Guidance on preparing a written care plan.
- How often the CPT code 99483 can be used.
- Other CPT codes that can and cannot be reported in conjunction with this code.