Section 116 of the Consolidated Appropriations At, 2020 P.L., (116-260) requires CMS to conduct provider outreach and education for the Medicare-covered Cognitive Assessment & Care Plan Services (CPT code 99843) to increase awareness of this service and its eligibility requirements. In a recent “Change Request” ®, the requirements for provider outreach and education, including a direct mailing from the Medicare Administrative Contractors (MACs) to eligible clinicians, including physicians, nurse practitioners, clinical nurse specialists, and physician assistants; about Medicare-covered Cognitive Assessment & Care Plan Services are outlined. The education and mailing will raise general awareness of the benefit and provide information on eligibility and billing.

In summary, if the physician, or other clinician eligible to bill Evaluation and Management services, finds a patient shows signs of cognitive impairment during a routine visit, Mediare covers a separate visit to more thoroughly assess the patient’s cognitive function and develop a plan of care. The cognitive assessment includes a detailed history and patient exam. There must be an independent historian for assessments and corresponding care plans provided under CPT code 99483. Clinicians will use information gathered during the cognitive assessment to help create a written care plan.

Your residents may be impacted by this program if they visit their primary care physicians in a clinic setting. It will be interesting to see if these services are also covered in the post-acute care setting as many of our residents could use additional support with care planning and goals. Stay well, mask up indoors and stay tuned!