99483
Cognitive assessment & care plan
Cognitive assessment and care planning services for a patient with cognitive impairment, typically 60 minutes face-to-face. CMS 2026 wRVU 3.44. Once per 180 days per beneficiary. Structured service with 10 required elements that must all appear in the documentation.
When to use it
99483 is the Medicare-recognized service for a comprehensive cognitive assessment with care plan, billed in patients with mild cognitive impairment, dementia (any stage and any cause), or strong clinical suspicion of cognitive impairment. Use it when you are establishing or revisiting a comprehensive care plan: an initial assessment for memory complaints in a 75-year-old, an annual re-evaluation for a known Alzheimer's patient, or a post-hospital cognitive assessment in a patient with new functional decline.
Full guidance
The visit must cover 10 required elements and result in a written care plan shared with the patient and caregiver. Once per 180 days per beneficiary; you cannot stack two 99483 visits within the same six-month window. Qualifying diagnoses include G30.x (Alzheimer's), G31.84 (mild cognitive impairment), F01.x (vascular dementia), F03.x (unspecified dementia), G31.83 (dementia with Lewy bodies), and G31.09 (frontotemporal dementia). The 60-minute benchmark is typical but the code is not strictly time-based; the 10 structural elements drive billability.
Documentation checklist
- ✓Cognition-relevant history including timeline of symptoms, behavioral changes, and functional changes.
- ✓Standardized cognitive testing using a validated tool: MMSE, MoCA, SLUMS, or Mini-Cog, with the documented numeric score.
- ✓Functional assessment of ADLs and IADLs (bathing, dressing, eating, managing finances, managing medications, driving).
- ✓Medication reconciliation, with attention to drugs with anticholinergic, sedative, or cognitive-impairing potential.
- ✓Evaluation for neuropsychiatric and behavioral symptoms (depression, anxiety, agitation, psychosis, sleep disturbance) using validated tools when present.
- ✓Safety evaluation: home safety, driving safety, wandering risk, falls, financial-exploitation risk.
- ✓Caregiver assessment: identify the primary caregiver, assess caregiver burden, and evaluate caregiver capacity to support the care plan.
- ✓Advance care planning discussion with the patient and caregiver. A separate 99497 may not be billed on the same day; the ACP element is bundled into 99483.
- ✓Written care plan addressing each domain assessed, with specific recommendations, follow-up schedule, and referrals.
- ✓Care plan shared with the patient, caregiver, and ideally the patient's other treating clinicians.
Common pitfalls
- !Billing 99483 without all 10 required elements documented. CMS audits 99483 aggressively because of its high wRVU; missing even one element (most commonly caregiver assessment or written care plan) is grounds for full denial.
- !Repeating 99483 within 180 days of the prior 99483 for the same patient. Frequency cap is strict.
- !Billing 99483 with 99497 on the same date. ACP is bundled into 99483; you cannot also bill 99497.
- !Insufficient validated testing. "Patient appears cognitively impaired" without a documented score on MMSE, MoCA, SLUMS, or Mini-Cog will fail audit.
- !Billing 99483 via telehealth without verifying payer acceptance. Medicare covers 99483 via audio-video telehealth at POS 02 or POS 10 with modifier 95, but the in-person tests (Mini-Cog, gait observation) must be administrable remotely.
- !Missing the written care plan. A note that says "will follow up in 3 months" is not a care plan. The plan must address each assessed domain with specific recommendations.
Payer notes
Medicare covers 99483 once per 180 days with standard cost share; most Medicare Advantage plans follow. Commercial payer coverage varies: many cover 99483 but with prior authorization, some prefer 96130 (psychological assessment) bundled with E/M. Patient cost share for Medicare 99483 can exceed $100; consider obtaining advance financial consent. Telehealth coverage is established post-PHE for Medicare; commercial varies. The high wRVU and 180-day frequency make 99483 a high-yield service to capture for any clinician routinely seeing patients with cognitive impairment.