Dementia Care Planning - Washington State Local Health Insurance - CHPW

Dementia Care Planning

New service for Dementia Care Planning effective 1-1-2022.  This is to provide access to clients requiring this service and who are not covered by Medicare – this is a Medicare covered service.

  • Code:
    • 99483 Comprehensive Assessment and Care Planning code will be added to the Physician-Related Services/Health Care Professional Services billing guide and update the fee schedule
  • Billing
    • Providers may bill the code for patients with cognitive impairment
    • Rate to be determined, current Medicare reimbursement rate is $282
    • 99483 is not allowed to be billed with a E&M code in the same encounter (see list below)
    • Reimbursement only available for qualified patients with an independent historian, limited to once every 180 days

Allowable ICD 10 codes:

Code Description
G300 Dementia Alzheimer’s disease with early onset
G301 Dementia Alzheimer’s disease with late onset
G309 Dementia Alzheimer’s disease, unspecified
F01.50 Vascular dementia without behavioral disturbance
F01.51 Vascular dementia with behavioral disturbance
F02.80 Dementia in other diseases classified elsewhere without behavioral disturbance
F02.81 Dementia in other diseases classified elsewhere with behavioral disturbance
F03.90 Unspecified dementia without behavioral disturbance
F03.91 Unspecified dementia with behavioral disturbance
G31.01 Pick’s disease
G31.09 Other frontotemporal dementia
G31.85 Corticobasal degeneration
G31.83 Dementia with Lewy bodies
G31.84 Mild cognitive impairment, so stated

 

CPT codes that cannot be reported in conjunction with 99483 since some of the service elements under 99483 overlap with services under some E/M codes, advance care planning services, and certain psychological or psychiatric service codes.

Code
90785 – Psytx complex interactive
90791 – Pysch diagnostic evaluation
90792 – psych diag eval w/med services
96103 – psycho testing admin by comp
96120 – neuropsych test admin w/comp
96127 – brief emotional/behavioral assmt
99201-99215 – Office/outpatient visits
99324-99337 – domicil/r-home visits new pat
99341-99350 – Home visits
99366-99368 – team conf w/pat by hc prof
99497 – advncd care plan 30 min
99498 – advcd care plan addl 30 min

 

CPT codes that CAN be reported with 99483 on the same day of service

Code Description
99358, 99359 Non-face-to-face prolonged services
99487, 99489, 99490 Chronic care management services
99495, 99496 Transitional care management services

 

Cognitive Care Planning Resource

 The Dementia Action Collaborative created this easy-to-digest resource for families, the “Dementia Road Map: A Guide for Family and Care Partners”.  It offers practical information to families as they enter into, live with and navigate the dementia journey.  It is just as useful to clinicians as they strive to support their patients.

The “Dementia Road Map” is available in English and Spanish.  You can view it online or order paper copies at low cost.

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