N.C. Medicaid to cover cognitive assessments and care planning

We have another exciting policy update to share during Alzheimer’s and Brain Awareness Month. NC Medicaid has announced coverage of CPT Code 99843, which will expand access to cognitive assessments and care planning for North Carolinians.

“This is a huge win for North Carolinians who may be experiencing symptoms of cognitive decline,” said Lindsey Golden, director of state affairs for the Alzheimer’s Association North Carolina Chapters. “Not only will a new population have access to cognitive assessments, but care planning that includes medication and safety evaluations (including driving), advance care planning, and a written care plan to guide patients and their loved ones.”

CPT 99483 is defined as the assessment of and care planning for a patient with cognitive impairment, requiring an independent historian, in the office or other outpatient setting, such as a home, domiciliary, or rest home.

Better care requires conversations about memory at the earliest point of concern, along with an accessible care team that can diagnose, monitor disease progression, and treat when appropriate. This is especially true now, in an era when treatments that change the underlying biology of Alzheimer’s are available.

As of 2018, if a patient shows signs of cognitive impairment during a routine visit, Medicare covers a separate visit to more thoroughly assess a patient’s cognitive function and develop a care plan, through CPT 99483. With this code, clinicians have the time and resources to provide a comprehensive set of care planning services to individuals with cognitive impairment and their caregivers, but only if they are 65 years or older and enrolled in Medicare.

As a result, persons with younger-onset Alzheimer’s, who are typically under the age of 65 years, did not have the same access to critical care planning services that can result in long-term savings to the individual and the State. We applaud NC Medicaid for changing this and offering coverage for CPT 99483. This policy change was a direct result of the Alzheimer’s Association’s state policy work. To learn more about our state policy priorities and ways to get involved, visit https://alzimpact.org/North_Carolina.