As of 1/1/2017, CMS has approved payment for a new G-code, G0505, describing assessment and care plan services for patients with cognitive impairment. Although this code is likely to be converted into permanent CPT code approved by the CPT Editorial Panel until 2018, CMS plans to pay for this service in 2017 using a new G-code, G0505.
Code & Definition: G0505 – Cognition and functional assessment using standardized instruments with development of recorded care plan for the patient with cognitive impairment, history obtained from patient and/or caregiver, by the physician or other qualified health care professional in office or other outpatient setting or home or domiciliary or rest home.
Performing providers: G0505 represents a service that can only be performed by a physician or qualified non-physician practitioner (nurse practitioner or physician assistant).
Limits with other services: The following services should not be billed on the same date of service as G0505:
90785, 90791 & 90792, 96103, 96120, 96127, 99201-99215, 99324-99337, 99341-99350, 99366-99368, 99497 and 99498.
Allowed with chronic care management and transitional care management: G0505 may be billed on the same date of service or same service period as CCM (CPT codes 99487, 99489 and 99490) and also with TCM (CPT codes 99495 and 99496). CMS has determined that cognitive assessment does not significantly overlap with either of these service sets.
Providers performing and billing for G0505 must include the following elements in the service, all of which are expected to be clearly documented in the associated medical record for the service:
- Cognition-focused evaluation including a pertinent history and examination
- Medical decision making of moderate or high complexity (defined by the E&M guidelines)
- Functional assessment (for example, basic and instrumental activities of daily living), including decision-making capacity
- Use of standardized instruments to stage dementia
- Medication reconciliation and review for high-risk medications, if applicable
- Evaluation for neuropsychiatric and behavioural symptoms, including depression, including use of standardized instrument(s).
- Evaluation of safety (for example, home), including motor vehicle operation, if applicable
- Identification of caregiver(s), caregiver knowledge, caregiver needs, social supports, and the willingness of caregiver to take on caregiving tasks.
- Advance care planning and addressing palliative care needs, if applicable and consistent with beneficiary preference
- Creation of a care plan, including initial plans to address any neuropsychiatric symptoms and referral to community resources as needed (for example, adult day programs, support groups) care plan shared with the patient and/or caregiver with initial education and support.
For 2017, CMS has set the average payment amount for G0505 at $238.30.
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