Cognitive Assessment and Care Plan Services

Did you know Medicare reimburses for a comprehensive Cognitive Assessment and Care Plan visit for patients who would benefit? A recently published CMS webpage offers additional guidance about the requirements. The Medicare Physician Fee Schedule increased the national payment amount for this service to $282 in 2021.

Important considerations for what should be included in a Cognitive Assessment and Care Plan visit:

• Screening for cognitive impairment is still a requirement of Medicare Annual Wellness Visits. This visit would be a separate, more comprehensive, service for patients who need further evaluation to diagnose or stage their dementia and provide additional care planning resources for caregivers. Cognitive Assessment and Care Plan visits may be billed up to once every six months.
• A functional assessment of Basic and Instrumental Activities of Daily Living, including decision-making capacity, and use of a standardized instrument for the staging of dementia − such as the Functional Assessment Staging Test and Clinical Dementia Rating − is required. (Refer to table 1 of this Alzheimer’s Association resource for other suggested measures and screenings.)
• A written cognitive-specific care plan. CMS further clarified that the written care plan includes details to initially address the following:
  • Neuropsychiatric symptoms
  • Neurocognitive symptoms
  • Functional limitations
  • Patient or caregiver referrals to community resources, as needed, with initial education and support
• A template to help your providers document the required elements of this service is strongly recommended.

For template creation guidelines and other ways to maximize reimbursement for your practice, refer to the guidance included in HCCI’s Advanced Coding Opportunities resource.