The Cognitive Health Assessment (CHA), which is a 5-10 minute screening, can fit into several types of visits. This includes routine visits, Medicare visits such as Initial and Subsequent Annual Wellness Visits (AWV), and during Health Risk Assessments.
Who counts as a billing provider?
Medicare | Medi-Cal |
|---|---|
Physicians (MD and DO) | Physicians (MD and DO) |
Nurse Practitioners | Nurse Practitioners |
Physician Assistants | Supervising Physicians on behalf of Physicians Assistants |
Clinical Nurse Specialists | Column Two Text |
How do I bill for dementia screening, assessment, care planning, and care management?
The table below outlines the codes associated with visit types and services in which a cognitive screen is indicated and therefore the cognitive health assessment can be used. Given that the majority of people over 65 have Medicare, and Medicare is the primary payor for those who have both Medicare and Medi-Cal, an understanding of billing for cognitive assessment under Medicare is important.
Coverage | Visit Type | Billing Code | Things to know |
|---|---|---|---|
Dual-eligible or Medicare only beneficiary | Initial Annual Wellness Visit
| G0438 | You can use the cognitive health assessment to satisfy the required AWV cognitive impairment screen |
Dual-eligible or Medicare only beneficiary | Subsequent AWVs | G0439 | You can use the Cognitive health assessment to satisfy the required AWV cognitive impairment screen |
Dual-eligible, Medicare only, and Medi-Cal only beneficiary† | Cognitive Assessment and Care Planning (50 minute) * | CPT code 99483 | The cognitive health assessment alone does not meet criteria for this code – please review the billing and coding FAQ for more information
|
Medi-Cal only beneficiary †
| Cognitive health assessment | 1494F | Billing provider must complete the Dementia Care Aware cognitive health assessment (CHA) to use the billing code. |
*Dementia Care Aware resources will provide guidance to meet the criteria for this code. See website for on-going updates.
† Providers can only bill Medi-Cal for this code if the patient does NOT have Medicare.
Qualifying CHA screenings are eligible for reimbursement under the new billing code CPT-4 code 1494F
Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs), or Tribal Health Programs are not eligible to receive additional payments for Dementia Care Aware/Cognitive Health Assessment (CHA) services via the fee-for-service system. The health assessment is a component of an evaluation and management visit and as such, it is reimbursed via the Prospective Payment System (PPS) Rate, All-Inclusive Rate (AIR), or Tribal FQHC APM (set at AIR). If additional payment were to be received, the Medi-Cal Managed Care Plan revenue must be included in the FQHC/RHC’s annual Reconciliation Request.
The 1494F CPT code can be used when a CHA-trained provider performs the screening for a Fee for service Medi-cal only beneficiaries over 65. The Medi-cal Managed Care Plan can chose to provide payment to CHA-trained providers. It is up to each Medi-Cal Managed Care Plan to determine if they will provide additional payment to their providers for the service.
