Cognitive decline — including Alzheimer's disease and other dementias — can be difficult and time consuming to discuss with patients. In-depth dementia care planning is beneficial for all, and is covered under Medicare.

Cognitive assessment and care plan services

CPT® code 99483 provides reimbursement for a clinical visit that results in a comprehensive care plan, allowing you to deliver services that can contribute to a higher quality of life for your patients. Clinicians who can be reimbursed under the code include: physicians, physician assistants, nurse practitioners, clinical nurse specialists and certified nurse midwives.

Care planning for individuals living with dementia is an ongoing process and a formal update to a care plan should occur at least once per year or when indicated by disease progression.

Who is eligible to receive the services?

Individuals who are cognitively impaired are eligible to receive the services under this code. This includes those who have been diagnosed with Alzheimer's, other dementias, or mild cognitive impairment. It also includes those individuals without a clinical diagnosis who, in the judgment of the clinician, are cognitively impaired.

What elements are required?

A cognition-focused exam is comprehensive, and an interview with a family member or caregiver is always desirable and often necessary to obtain an accurate history and description of current issues. 

The nine assessment service elements of 99483 listed below 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 less complex problems may be fully assessed during the care plan visit itself.

Service elements of CPT Code 99483

Cognition-focused evaluation, including a pertinent history and examination of the patient
Medical decision making of moderate or high complexity (defined by the E/M guidelines) Document medical decision-making of moderate or high complexity as defined by E/M guidelines
Functional assessment (for example, Basic and Instrumental Activities of Daily Living)
Medication reconciliation and review for high-risk medications, if applicable Medication list and name of person overseeing home medications
Evaluation for neuropsychiatric and behavioral symptoms, including depression and including use of standardized instruments
Evaluation of safety (for example, home safety), including motor vehicle operation, if applicable
Identification of caregiver(s), caregiver knowledge, caregiver needs, social supports and the willingness of caregiver to take on caregiving tasks
Advance care planning and addressing palliative care needs, if applicable and consistent with beneficiary preference

Creation of a care plan, including initial plans to address any neuropsychiatric symptoms and referral to community resources as needed (for example, adult day programs and support groups)

The care plan must be shared with the patient and/or caregiver at the time of initial education and support, and this discussion must be documented in the clinical note for all encounters billed using 99483.


Resources to help you deliver care

The Alzheimer's Association has compiled a comprehensive toolkit to help you conduct a visit under the code. The toolkit includes easy access to validated measures, such as the Mini-Cog™ and Dementia Severity Rating Scale, and assessment tools:

Medicare's Cognitive Impairment Assessment and Care Planning Code

Cognitive Assessment and Care Planning Services:

The Alzheimer's Association Expert Taskforce recommendations and tools for implementation.

Download (PDF)

Safety Assessment Guide and Checklist

Safety Assessment Guide and Checklist:

Questions to identify safety-related concerns and outline steps to keep the dementia patient safe.

Download Checklist (PDF)

Caregiver Profile Checklist

Caregiver Profile Checklist:

Assess a caregiver's ability and willingness to provide care.

Download Checklist (PDF)

End Of Life Checklist

End-of-Life Checklist:

Screen to identify care preferences and legal needs.

Download Checklist (PDF)

Patient and Caregiver Resources

Patient and Caregiver Resources:

Links to helpful caregiving, safety and end-of-life resources.

Download Resources (PDF)
Download Toolkit (PDF)