A memory-care expert is the latest advocate for the more frequent use and possible expansion of Medicare’s largely untapped dementia care planning benefit.

“We must study who is using this code and who is not, why and how well it works,” Jason Karlawish, M.D., told the Senate Committee on Finance in a Wednesday hearing that sought to shed light on barriers to Alzheimer’s diagnosis and treatment. “We should do this with the same urgency as our studies of Alzheimer’s biomarkers.”

The CPT code 99483, “Cognitive Assessment and Care Plan Services,” covers a comprehensive assessment for adults with cognitive impairment, including dementia, and includes the creation of a care plan. “These billing codes are a tremendous steps forward,” said Karlawish, who is co-director of Penn Memory Center at the Hospital of the University of Pennsylvania. The problem is that they are not yet in frequent use, he added.

In 2017, the first year the benefit was available, fewer than 1% of eligible Medicare recipients living with cognitive impairment received care planning, according to a recent study

In fact, Karlawish’s employer currently does not make use of the code. At Penn Memory Center, social workers perform care planning, and are not covered to provide this service, he said.

Among other recommendations, Karlawish suggested that Medicare study how to integrate the code into its Comprehensive Primary Care Plus initiative, and consider covering ongoing case management. In addition, the code should expand the range of clinicians who are covered for performing care planning services, he said. 

“The code should recognize that many of the services for dementia care are effectively and efficiently delivered by nurses, social workers, and community health workers,” he concluded.

More coverage of the hearing can be found at McKnight’s Senior Living.