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.
