The Centers for Medicare & Medicaid Services (CMS) recently approved a new Medicare service that will improve access to care planning and related services for persons with cognitive impairment, including Alzheimer’s disease and related dementias.
Beginning on January 1, 2017, Medicare will begin covering assessments and care planning with a medical professional for those living with cognitive impairments. Medicare has created a billing code “G0505” that will allow physicians and other clinicians to be reimbursed for providing a series of services to persons with cognitive impairment. These services include:
• Cognition-focused evaluation including a pertinent history and examination.
• 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 behavioral 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.
This new service is a positive development, as many as half of individuals who meet the specific diagnostic criteria for dementia have never received a diagnosis. An early and documented diagnosis when coupled with access to care planning services leads to better outcomes for individuals with Alzheimer’s as well as their caregivers.
Furthermore, documentation in the individual’s medical record is critical for care coordination and is necessary for health care providers to address complications in the management of other chronic conditions, such as heart disease and diabetes.