Alzheimer’s disease (AD) and other dementias are under-recognized and under-diagnosed in the community. Primary care practitioners are the most likely provider to detect early symptoms of AD and other dementias in older adults. In primary care settings, providers can expect 11% of people 65 and older and 32% of those 85 and older to have AD, with the incidence expected to rise due to the increasing number of people aged 65 and older. Screening to identify older adults early in the disease process is important to offer treatment and future planning for the patient and their family caregivers.
Medi-Cal benefits include an annual cognitive assessment for Medi-Cal members who are 65 years of age and older. Members with CareAdvantage are excluded from this policy as cognitive assessments are already covered as part of the Medicare Annual Wellness Visit (AWV).
The annual cognitive health assessment is intended to detect early signs of memory or thinking changes, identify potential cognitive impairment, and guide patients toward comprehensive diagnostic evaluations or specialized care when necessary.
Providers are no longer required to complete a cognitive health assessment training in order to receive payment for conducting a cognitive health assessment.
Medi-Cal Providers must use validated tools recommended by the Department of Health Care Services (DHCS).
For billing, use CPT II code 1494F - Cognitive health assessment performed. 1494F has a frequency limit of once per year, per same provider. Do not report CPT code 99483 (Assessment of and care planning for patients with any cognitive impairment, like dementia, including Alzheimer’s disease, at any stage of impairment) with CPT code 1494F.
Any licensed health care professional who is enrolled as a Medi-Cal Provider, is acting within their scope of practice, and is eligible to bill Evaluation and Management (E&M) codes is eligible to conduct and bill for cognitive health assessments.
Provider Billing Requirements
- Administer the annual cognitive health assessment as a component of an E&M visit including, but not limited to an office visit, consultation, or preventive medicine service (elements of the cognitive health assessment can be conducted by non-billing team members acting within their scope of practice and under the supervision of the billing Provider);
- Document all of the following in the Member’s medical records and have such records available upon request:
- The screening tool or tools that were used (at least one cognitive assessment tool listed below is required);
- Verification that screening results were reviewed by the Provider;
- The results of the screening;
- The interpretation of the results; and
- Details discussed with the Member and/or Authorized Representative and any appropriate actions taken in regards to screening results.
Cognitive Assessment Tools
At least one cognitive assessment tool listed below is required. Cognitive assessment tools used to determine if a full dementia evaluation is needed include, but are not limited to:
- Patient assessment tools
- Informant tools (family members and close friends)
Based on the scores from these assessments, additional assessment or a specialist referral may be appropriate. For the CareAdvantage patient, refer to the CMS Cognitive Assessment & Care Plan Services webpage.