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Examining the adoption of a new Medicare billing code for cognitive assessments: a slow but steady uptake

 On January 1, 2017, the Medicare program started reimbursing providers for a new procedure code for clinical visits for cognitive assessments and care planning services (CPT code G0505). This newly-billable service is intended to improve the care of patients with Alzheimer's disease and related dementias and hopefully increase early detection and diagnosis. A G0505 visit includes a complete patient history; review and reconciliation of prescription medications; assessment of patient cognition, function, and safety; evaluation of symptoms; discussion of the needs of the patient's caregiver; and a written care plan. Given the potential benefits of this service for patients, families, and caregivers, HCCI collaborated with the Alzheimer's Association to assess the extent of its adoption by examining HCCI's 2017 Medicare fee-for-service (FFS) and Medicare Advantage (MA) claims data.

Key Findings

  • In Medicare FFS, there were 556 patients with a G0505 visit per 1,000,000 beneficiaries in 2017.
    • 18,669 unique Medicare FFS beneficiaries had a G0505 visit in 2017.
  • In Medicare Advantage, there were 394 patients with a G0505 visit per 1,000,000 beneficiaries in 2017.
    • 2,857 unique Medicare Advantage enrollees had a G0505 visit in 2017 (estimate based off of HCCI claims data on 37% of the MA population).
  • Use of the new service was low during the first few months after its introduction but increased steadily throughout the year.
    • The utilization rate of G0505 in Medicare FFS was 3.3 times higher in the fourth quarter of 2017 than it was in the first quarter, and 3.8 times higher for MA.
  • Methods Note

    We looked at all claims with procedure code (CPT/HCPCS) G0505 in calendar year 2017 in Medicare fee-for-service (FFS) Part B Carrier lines data and HCCI physician services (PH_SDDV2) data on Medicare Advantage (MA) enrollees. Claim lines with procedure code G0505 were combined by unique patient ID and dates of service creating G0505 visits to account for any adjustments or duplicative coding of claims. We excluded any visits that had allowed amounts less than or equal to zero dollars. We identified 20,629 G0505 visits for 18,669 unique patients in Medicare fee-for-service (less than 0.06% of the Medicare FFS population) and 3,047 G0505 visits for 2,857 unique Medicare Advantage patients. Utilization rates were calculated using average annualized members, for FFS the utilization rate denominator was total Part B beneficiary member months divided by 12; for MA the utilization rate denominator was total MA enrollee member months divided by 12. To calculate monthly utilization rates we calculated unique patients in a given month and total beneficiaries enrolled in that month.

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