Cognitive Health Assessment
Provider Type
- Physicians and Practitioners
- Participating Physician Groups (PPG)
Medi-Cal providers must use cognitive assessment tools recommended by the Department of Health Care Services (DHCS) when conducting annual cognitive health assessments for eligible members age 65 and older who are not eligible for a similar assessment as part of a Medicare annual wellness visit.
Assessment tools
Providers must conduct the cognitive health assessment using at least one cognitive assessment tool recommended by the DHCS. Cognitive assessment tools used to determine if a full dementia evaluation is needed include, but are not limited to:
- Patient assessment tools
- General Practitioner assessment of Cognition (GPCOG)
- Mini-Cog
- Informant tools (family members and close friends)
- Eight-item Informant Interview to Differentiate Aging and Dementia
- GPCOG
- Short Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE)
Based on the scores from these assessments, additional assessment or a specialist referral may be appropriate.
Billing
For current billing, reimbursement, CPT coding, and quantity limit information related to annual cognitive health assessments, refer to the applicable DHCS guidance and the Medi-Cal Provider Manual, Evaluation & Management (E&M) section. The Medi-Cal Provider Manual is available on the DHCS website.
Documentation Requirements
Providers must maintain documentation for the following:
- The screening tool used.
- Screening results.
- Provider review of the results.
- Interpretation of the results.
- Discussions with the member and/or authorized representative and any actions taken.
For more information, see DHCS All Plan Letter (APL) 26-014, Responsibilities for Annual Cognitive Health Assessment for Eligible Members 65 Years of Age or Older (PDF).