Healthcare providers may use several CPT codes for cognitive function testing and care planning. Each code serves a distinct purpose and has specific requirements. These codes facilitate the detection, diagnosis, and management of cognitive impairment, including Alzheimer's disease and other dementias.
Here are the key distinctions between the major CPT codes a provider might use for cognitive function testing and how each one may be applied.
NOTE: Neurotrack is providing this information for illustrative purposes only. Providers should rely on the coding departments of their own organizations for accurate and up-to-date information and to verify that the codes they’re using are the right ones for each case.
CPT Code 99483: Cognitive Assessment and Care Plan Service
This code is used for a comprehensive clinical visit that results in a written care plan for patients with cognitive impairment. It provides reimbursement to eligible practitioners for a detailed assessment and care planning specific to cognitive decline.
Purpose and Eligibility: Detecting cognitive impairment is a required element of Medicare's Annual Wellness Visit (AWV). Also note:
- If cognitive impairment is detected during an AWV or routine visit, Medicare covers a separate visit for a more thorough assessment and care plan using CPT code 99483.
- It is specifically for Medicare patients who have already demonstrated signs of cognitive impairment.
- It can be used to diagnose mild cognitive impairment (MCI) or dementia, and identify treatable causes or co-occurring conditions like depression or anxiety.
- All beneficiaries who are cognitively impaired are eligible, including those diagnosed with Alzheimer's, other dementias, or mild cognitive impairment, as well as individuals without a clinical diagnosis who are judged by the clinician to be cognitively impaired.
Required Service Elements for 99483: According to CMS, in order to bill for 99483, these required elements must be performed.
- Cognition-focused evaluation, including a pertinent history and examination. Documentation should include factors contributing to impairment (e.g., psychoactive medications, chronic pain, depression) and a narrative history that spurred suspicion for cognitive impairment.
- Medical decision-making of moderate or high complexity. Documentation should reflect the current and likely progression of the disease and the need for referrals.
- Functional assessment (e.g., Basic and Instrumental Activities of Daily Living), including decision-making capacity. Standardized tools like the Katz Index of Independence in Activities of Daily Living or the Lawton-Brody Instrumental Activities of Daily Living Scale (IADL) are required.
Use of standardized instruments to stage dementia (e.g., Functional Assessment Staging Test [FAST], Clinical Dementia Rating [CDR]). These tools require the involvement and identification of an independent historian in the medical record. - Medication reconciliation and review for high-risk medications.
Evaluation for neuropsychiatric and behavioral symptoms, including depression, using standardized instruments.
Evaluation of safety, at home and otherwise, including motor vehicle operation. - Identification of caregiver(s), caregiver knowledge, caregiver needs, social supports, and willingness of caregiver to take on caregiving tasks.
- Development, with periodic updating/revision/review of an Advance Care Plan.
- Creation of a written care plan including initial plans to address neuropsychiatric symptoms, neurocognitive symptoms, functional limitations, and referral to community resources (e.g., rehabilitation services, adult day programs, support groups). This plan must be documented as having been shared with the patient and/or caregiver at the time of initial education and support.
Who Can Perform: Any clinician eligible to report Evaluation and Management (E/M) services. This includes:
- Physicians (MD and DO)
- Nurse practitioners (NP)
- Clinical nurse specialists (CNS)
- Physician assistants (PA)
Duration and Frequency: Typically, 60 minutes of total time is spent face-to-face with the patient and/or family or caregiver on the date of the encounter. Also note:
- The 10 assessment elements do not have to be performed on the same day; they can be evaluated in one or more preceding visits using appropriate billing codes (often E/M codes), as long as they occurred within approximately 3 months of the care plan visit to assure relevance.
- A single practitioner should not report 99483 more than once every 180 days per patient.
- Care plans should be revised at regular intervals and whenever there's a change in the patient's clinical or caregiving status.
Billing Considerations: Can be billed separately from the Annual Wellness Visit (AWV). Also note:
- If performed at the same visit as an AWV, a -25 modifier must be appropriately utilized, indicating a significant, separately identifiable E/M service.
- Includes elements comparable to a Level 5 E/M service (CPT code 99215), such as comprehensive history, comprehensive exam, and high complexity medical decision-making.
- Can be billed with HCPCS code G2212 if the visit exceeds the 60-minute timeframe.
- Cannot be reported together with numerous other CPT codes on the same date of service due to overlapping elements, including various psychiatric, psychological testing, and E/M codes. Examples include:
- 90785 (Interactive Complexity)
- 90791, 90792 (Psychiatric Diagnostic Evaluation)
- 96127 (Brief emotional/behavioral assessment)
- 99202-99215 (Office or Other Outpatient Visits)
- 99341-99350 (Home or Residence Visits)
- 99497, 99498 (Advance Care Planning)
- Care planning visits can be conducted in the office, outpatient setting, home, domiciliary, rest home, or via telehealth. Medicare permanently covers 99483 services via telehealth.
CPT Codes for Neuropsychological Testing
These codes are generally used for the administration, scoring, and evaluation of cognitive abilities and brain function, often by specialists.
CPT Code 96138: Neuropsych test administration and scoring
Description: Used for the administration and scoring of two or more neuropsychological tests by any method.
Duration & Frequency: Covers the first 30 minutes, with a minimum of 16 minutes face-to-face.
Who Can Perform: Medical Assistants (MA) or Registered Nurses (RN).
CPT Code 96136: Neuropsych test administration and scoring (by physician/NP/PA)
Description: Similar to 96138, but specifically for the administration and scoring of two or more neuropsychological tests by a physician, nurse practitioner (NP), or physician assistant (PA).
Duration & Frequency: Covers the first 30 minutes, with a minimum of 16 minutes face-to-face.
Who Can Perform: MD, NP, PA.
Note: CPT Code 96137 is an add-on code for each additional 30 minutes of psychological or neuropsychological test administered and scored by an MD, NP, PA.
CPT Code 96132: Neuropsych testing and evaluation (by physician or qualified health professional)
Description: Covers the testing and evaluation services by a physician or other qualified health professional. This code includes the integration of patient data, interpretation of standardized test results, clinical decision-making, treatment planning, and interactive feedback to the patient and/or family/caregiver.
Duration & Frequency: Covers the first 60 minutes, including both face-to-face and non-face-to-face time (minimum 31 minutes total).
Who Can Perform: MD, DO, NP, CNS, PA, CSW (Clinical Social Worker, although note that a CSW is not listed as eligible for 99483 in some sources).
Understanding Neuropsychological Coding Distinctions
While both psychological and neuropsychological evaluations use overlapping tests, neuropsychological testing (96132/96133) specifically assesses cognitive functions related to brain behavior (e.g., memory, attention, language, problem-solving), and is used to diagnose neurological conditions.
Psychological testing (96130/96131) evaluates mental health and cognitive abilities, including emotional well-being and personality traits.
Some experts suggest it's best to avoid combining these on the same superbill.
A cognitive assessment within a comprehensive psychological evaluation can qualify as neuropsychological if it addresses domains like attention, memory, executive functioning, and processing speed.
Other Related Codes
- G0438 / G0439 (Annual Wellness Visit - AWV): These codes are for the initial (G0438) and subsequent (G0439) AWVs, during which detecting cognitive impairment is a required element.
- G0513 / G0514 (AWV prolonged preventive service): Useful if an AWV exceeds the typical time.
- 96146 (Administration of a single, standalone automated neuropsych test): Useful in virtual care or when a single test needs to be repeated.
- 99213 / 99215 (Established patient visits): These are general Evaluation and Management (E/M) codes that might be used for routine patient visits where cognitive concerns are noted, or for focused cognitive visits. 99215 (high complexity) includes elements found in 99483.
- Modifier -25: Used when a significant, separately identifiable E/M service (like 99483) is performed by the same physician on the same day as another procedure or service (like an AWV).
