Provider Digest | Issue 14

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New annual cognitive health assessment requirement for Medi-Cal members 65+ years old

DHCS All Plan Letter 22-025 requires all individuals ages 65 and older who are members of California Medi-Cal managed care health plans (MCPs) to receive an annual cognitive health assessment.

DHCS has expanded this benefit for Medi-Cal only members who are ineligible for a similar assessment as part of the Medicare program. This assessment aims to identify whether individuals have signs of Alzheimer’s disease or related dementias, consistent with the standards for detecting cognitive impairment by the American Academy of Neurology (AAN)1.

Provider training requirement

All licensed health care professionals enrolled as Medi-Cal providers must complete DHCS-specified training and use DHCS-validated cognitive assessment tools (see next section for a list). Payment is based on the completion of the training. DHCS will maintain a list of providers who completed their training that will be shared with the Alliance. Complete the training on the Dementia Care Aware website.

DHCS approved cognitive assessment tools

Providers must complete at least one cognitive assessment tool listed below. These tools can help determine if a full dementia evaluation is needed:


As an Alliance provider, you may be asked to provide medical record documentation to ensure that appropriate screening tools are being used and the necessary follow-up services are being completed based on assessment scores.

Billing requirements

Alliance licensed health care professionals can conduct and bill for cognitive health assessments for members if they:

  • Are enrolled as a Medi-Cal provider.
  • Are acting within their scope of practice.
  • Are eligible to bill evaluation and management (E&M) codes.
  • Have completed the required training.
Billing Code Description
CPT Code 1494F


Only applicable for members 65 years of age and older without Medicare coverage.
CPT Code 99483 Comprehensive diagnostic evaluation and management (E&M) of a patient who exhibits signs and/or symptoms of cognitive impairment to establish or confirm a diagnosis, etiology or severity of the condition.
CPT Code 96125 Time spent administering standardized cognitive performance tests to the patient and time spent interpreting the results and preparing the formal medical report.

Note: 99483 and 96125 cannot be billed in conjunction with 1494F.

Documentation requirements

Providers are required to document the following in the member’s medical records, with records available upon request:

  • Screening tool(s) used.
  • Verification that screening results were reviewed by a provider.
  • Screening results and interpretation.
  • Details discussed with the member and/or authorized representative, and any appropriate actions taken regarding screening results.

If you have any questions regarding cognitive health training and/or screenings, please contact your Provider Relations Representative at 800-700-3874, ext. 5504.

Dementia Care Aware Warmline

The Dementia Care Aware Warmline is a consultative service for clinicians and primary care teams. You can get your questions answered about dementia care Monday-Friday via email or phone.

1AAN Guidelines on dementia and mild cognitive impairment: https://n.neurology.org/content/56/9/1143 and https://n.neurology.org/content/90/3/126

Understanding the risk of concurrent opioids and antipsychotics utilization

The U.S. Food and Drug Administration has warned about serious risks including death when combining opioids with drugs such as antipsychotics that suppress the central nervous system (CNS). This is due to the possibility of additive CNS depression.

Additionally, the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act requires that states have a review process to monitor patients concurrently prescribed opioids and antipsychotics. Concurrent use of these drug classes can result in excessive drowsiness, respiratory depression, overdose and death.

Per the CDC’s Clinical Practice Guideline for Prescribing Opioids for Pain, opioid therapy should only be initiated if expected benefits for pain and function are anticipated to outweigh risks to the patient.

When combined use of opioid and antipsychotic medication is warranted, please consider the following:

  • Talk with your patient about the realistic benefits and known risks of opioid therapy prior to initiating it.
  • Work with your patient to establish treatment goals for pain and function.
  • Consider utilizing the lowest effective opioid dose and minimum treatment duration.
  • Monitor your patient for adverse effects.
  • Regularly reevaluate benefits and risks of continued opioid therapy with your patient. If the benefits do not outweigh the risks, consider optimizing other therapies and working to gradually taper to lower dosages or, if warranted based on the individual circumstances of the patient, appropriately tapering and discontinuing an opioid medication.
  • Warn patients and caregivers about the risk of slowed breathing and/or sedation.
  • Consider co-prescribing naloxone.