Medicare Cognitive Assessments and Care Planning Services: Your Role
By the Health Affairs Committee
In a recent large cross-sectional study of older adults in the U.S., Manly and colleagues (2022) reported that approximately one-third of older adults have some degree of cognitive impairment, with roughly 10% having some form of dementia, including Alzheimer’s disease. They note that prevalence increases with age, with 3 to 4% of persons aged 65 to 74 affected, climbing to 18% of persons aged 80 to 84 and 35% of persons over the age of 90 (Manly et al., 2022). They also observed racial disparities; 15% of Black Americans aged 65 and greater had some degree of cognitive impairment in contrast with 10% of Hispanics/Latino Americans and 11% of white Americans. The Alzheimer’s Association (2024) states that nearly seven million Americans are living with Alzheimer’s disease, and these numbers are expected to increase as the population over 65 years grows from 56 million to 84 million (Caplan, 2023). Nurse Practitioners (NPs) play a key role in diagnosing and managing patients with cognitive impairment and can leverage Medicare’s Annual Wellness Visit (AWV) for an initial screening.
Beginning in 2011, Medicare began reimbursing primary care providers for a yearly appointment, the AWV, to create and update a patient-specific prevention plan (Centers for Medicare & Medicaid Services, n.d.). Providers may use the Mini-Cog©, the Memory Impairment Screen, or the AD8, among others, to screen for cognitive impairment. The Center to Advance Palliative Care recommends these tools as they are free, validated, and easy to use. Lind and colleagues (2022) found that the diagnosis of cognitive impairment increased following the implementation of the AWV, and now NPs can be reimbursed for a longer, more comprehensive visit to conduct further assessment and develop a plan of care.
Nurse practitioners have long recognized the importance of early identification and management of cognitive impairment, not only for the patient but also for the family. In 2018, Medicare began reimbursing providers for “Cognitive Assessments and Care Planning Services.” This visit (generally 50 minutes, either face-to-face or via telehealth) allows for a more detailed cognitive assessment to diagnose a patient and develop a care plan for the patient and family. Initially, Medicare reported approximately 30,000 assessments, and in 2022, that number grew to roughly 100,000. Assuming 10% of the population has some form of cognitive impairment, the opportunity to conduct additional assessments and care planning services remains. On average, these visits are reimbursed $270 and can be repeated every 90 days.
Nurse practitioners caring for older adults likely already complete these assessments and spend inordinate amounts of time of discussing the plan of care with the patient and family, now they can bill Medicare under with an additional code (99483). Identifying cognitive impairment early provides the opportunity to refer patients and families to support groups, educational forums and additional needed services. The Alzheimer’s Association developed the Cognitive Impairment Care Planning Toolkit, to support these care planning efforts.
If you’d like to learn more about dementia and become a Dementia Care Specialist, consider enrolling in GAPNA’s program based on the UCLA Alzheimer’s and Dementia Care program, The Dementia Care Specialist (DCS) Curriculum, supported by John A. Hartford Foundation and GAPNA.
Submitted on behalf of the Health Affairs Committee
References
Alzheimer’s Association. (2024). 2024 Alzheimer’s disease facts and figures. https://www.alz.org/media/Documents/alzheimers-facts-and-figures.pdf
Caplan, Z. (2023). U.S older population grew from 2010 to 2020 at fastest rate since 1880 to 1890. United States Census Bureau. https://www.census.gov/library/stories/2023/05/2020-census-united-states-older-population-grew.html
Centers for Medicare & Medicaid Services. (n.d.). Medicare wellness visits. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/preventive-services/medicare-wellness-visits.html
Lind, K.E., Hildreth, K., Lindrooth, R., Morrato, E., Crane, L.A., & Perraillon, M.C. (2021). The effect of direct cognitive assessment in the Medicare annual wellness visit on dementia diagnosis rates. Health Services Research, 56(2), 193-203. https://doi.org/10.1111/1475-6773.13627
Manly, J.J., Jones, R.N., Langa, K.M., Ryan, L.H., Levine, D.A., McCammon, R., Heeringa, S.G., Weir, D. (2022). Estimating the prevalence of dementia and mild cognitive impairment in the US: The 2016 health and retirement study harmonized cognitive assessment protocol project. JAMA Neurology, 79(12), 1242-1249. https://doi.org/10.1001/jamaneurol.2022.3543