Billing and Payment

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?

Any clinician eligible to report evaluation and management services can bill. Check with your state Medicaid office to learn more about billing providers’ eligibility in your state. Eligible providers by primary patient coverage type are:

Medicare	Medi-Cal
Physicians (MD and DO)	Physicians (MD and DO)
Nurse Practitioners	Nurse Practitioners
Physician Assistants	Physician Assistants
Clinical Nurse Specialists	Supervising Physicians on behalf of Physician Assistant

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 Medicaid/ 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	CPT-4 code 1494F	This code is only used for California based Medi-Cal beneﬁciaries who are 65 years or older and if they are otherwise ineligible for a similar assessment as part of an annual wellness visit through the Medicare Program.

*Dementia Care Aware offers resources that will provide guidance to meet code requirements. Refer to the website for ongoing updates.
† Providers can only bill Medicaid/Medi-Cal for this code if the patient does NOT have Medicare.

**In California, Qualifying Cognitive Health Assessment 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 is reimbursed through the Prospective Payment System (PPS) Rate, All-Inclusive Rate (AIR), or Tribal FQHC APM (set at AIR) when an eligible visit is billed. It is up to each Medicaid/Medi-Cal Managed Care Plan to determine if they will provide additional payment to their providers for the service. If additional payment is received, the Medicaid/Medi-Cal Managed Care Plan revenue must be included in the FQHC/RHC’s annual Reconciliation Request.

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