How to Report Cognitive Assessment and Care Planning: CPT Code 99483

CPT code 99483 is used for comprehensive cognitive assessment and care planning for individuals with conditions like dementia, mild cognitive impairment (MCI), or Alzheimer’s disease.

This code involves a thorough evaluation that includes:

Code	Description	Value
99483	Assessment and care planning for a patient with cognitive impairment, including input from an independent historian (e.g., caregiver or family member), performed in an office, home, or outpatient setting. Must include all required elements: Cognition-focused history Functional assessment (e.g., IADLs) Use of standardized instruments (e.g., cognitive tests, depression screenings) Medication reconciliation Advance care planning Development of a written care plan shared with the patient and/or caregiver	$266.21

*Fees are based on the Medicare National Fee Schedule, Non-Facility, 2025. Actual reimbursement values may vary by demographic location and payer

Billing Guidance

• A minimum of 50 minutes of total time must be documented on the date of service or across up to three consecutive service days to meet the time threshold for billing CPT 99483.

• Do not report CPT 99483 if any of the required elements are omitted or are not medically necessary based on the patient’s condition. In such cases, consider billing an appropriate evaluation and management (E/M) service (99202–99215) instead.

• Trained clinical team members may assist in gathering and documenting certain components of the assessment, including information collected from the caregiver. These elements may be completed prior to the encounter, provided they are reviewed and incorporated by the billing provider.

• Previously completed standardized assessments may be used to support the service, as long as they remain valid or are updated and relevant to the current visit.

• Frequency limitation: CPT 99483 is generally limited to once every 180 days per patient, unless otherwise specified by payer policy. Be sure to verify with individual payers for any additional restrictions or requirements.

It is important to note that Creyos can not determine eligibility for reimbursement and is not responsible for the outcome of any claims. The appropriate selection of CPT codes will depend on additional procedures performed, applicable CCI edits, and other relevant factors.

We recommend contacting your local payer to confirm coverage eligibility and to understand any specific coding or billing guidelines, including provider qualifications, time limitations, and requirements for modifiers.