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Elizabeth M. Whitehorn, Director

Provider Notice issued 01/11/2024

 

To: All Medical Assistance Program Providers
​Date: ​January 11, 2024
​Re: Confirmation of Coverage for Cognitive Assessments Per Public Act 103-0102

This notice confirms the Department of Healthcare and Family Services’ (HFS) coverage of cognitive assessments, effective January 1, 2024. This coverage is required under Public Act 103-0102 and applies to the fee-for-service (FFS) program and the managed care organizations (MCOs).

According to the Act, beginning on January 1, 2024, cognitive assessment and care planning services provided to a person who experiences signs or symptoms of cognitive impairment, as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, shall be covered under the Medical Assistance Program for persons who are otherwise eligible for Medical Assistance.

For compliance, HFS has opened procedure code 99483 – Psychiatric Assessment, Cognitive Impairment. HFS is utilizing the Centers for Medicare & Medicaid Services’ (CMS) guidance for coverage of 99483, including both a list of ICD-10 diagnoses for which the code is considered medically necessary and a list of services that are contra-indicated on the same service date.

Questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services at 877-782-5565, or the applicable MCO.

 

Kelly Cunningham, Administrator
Division of Medical Programs