Summary & Overview

CPT 1175F: Functional Status Assessment for Patients with Dementia

CPT code 1175F records a clinician’s assessment and review of functional status in patients with dementia, focusing on activities of daily living (ADL) and instrumental activities of daily living (IADL). This code is used to document evaluation of a patient’s ability to perform basic self-care and more complex tasks necessary for independent living, informing care planning, safety assessments, and coordination with caregivers. Nationally, accurate use of this code supports care quality measurement for dementia management and can influence care coordination across outpatient, long-term care, and home-based settings.

Key payers considered include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find clinical context for when the code is applicable, typical sites of service, and the role of the assessment in care planning. Data on payer-specific coverage terms, reimbursement benchmarks, and related policy updates are not included here; note that some sections may state when input data is not available.

This publication equips clinicians, billing staff, and policy analysts with a concise reference to the code’s clinical purpose, expected service context, and the types of information that documentation should capture to justify use of CPT code 1175F in national reporting and quality measurement.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare1175FCPTdementiafunctional assessmentADLIADLoutpatientcare coordination

Billing Code Overview

CPT code 1175F documents that the provider assesses the functional status of a patient with dementia and reviews the results. The assessment may evaluate the patient’s level of activities of daily living (ADL) and/or the status of instrumental activities of daily living (IADL).

Service Type: Clinical functional assessment focused on ADL/IADL evaluation for patients with dementia.

Typical Site of Service: Outpatient clinic or office-based setting, long-term care facility, or home-based visit where functional assessment and care planning are performed.

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A typical patient is a 78-year-old community-dwelling individual with known dementia who presents for a routine cognitive follow-up visit with a geriatrician or primary care clinician. The visit includes review of caregiver-reported changes in daily functioning, medication adherence, fall history, and ability to perform basic activities of daily living (ADLs) such as bathing, dressing, toileting, transferring, continence, and feeding, as well as instrumental activities of daily living (IADLs) such as managing finances, medications, transportation, shopping and meal preparation. The provider administers a structured functional assessment (paper or electronic ADL/IADL questionnaire), documents the results in the medical record, discusses findings with the patient and caregiver, and updates the care plan — for example arranging home health, durable medical equipment, safety interventions, or referrals to social work or neurology. Typical site of service is an outpatient office, geriatrics clinic, or home visit when conducted as part of chronic care management for dementia.

Coding Specifications

Modifier	Description	When to Use
`25`	Significant, separately identifiable evaluation and management service by the same physician on the same day	Use when an E/M visit is performed in addition to the functional assessment and is separately documented

Taxonomy Code	Specialty	Notes
`207Q00000X`	Geriatric Medicine	Specialists who commonly perform dementia functional assessments
`207L00000X`	Neurology	Neurologists who evaluate cognitive decline and functional impact
`207R00000X`	Family Medicine	Primary care clinicians managing dementia in outpatient settings
`208D00000X`	Internal Medicine	Internists providing longitudinal care and functional assessments
`251B00000X`	Psychology	Clinical psychologists involved in cognitive and functional evaluations

ICD-10 Code	Description	Clinical Relevance
`F03.90`	Unspecified dementia without behavioral disturbance	Common dementia diagnosis for which functional ADL/IADL assessment documents level of impairment
`F03.91`	Unspecified dementia with behavioral disturbance	Functional assessment helps identify how behavioral issues impact daily functioning and caregiver burden
`G30.0`	Alzheimer's disease with early onset	Functional assessment measures ADL/IADL decline associated with Alzheimer disease
`G30.1`	Alzheimer's disease with late onset	Functional assessment used to stage functional impact in late-onset Alzheimer disease
`F02.80`	Dementia in other diseases classified elsewhere without behavioral disturbance	Functional assessment documents impairment related to other neurological conditions
`R41.3`	Other amnesia	Functional assessment may be used when memory deficits affect daily living abilities
`F06.8`	Other specified mental disorders due to known physiological condition	Functional assessment documents impact of cognitive deficits from medical conditions on ADLs/IADLs

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99483`	Assessment of and care planning for a patient with cognitive impairment, including a detailed history, cognitive testing, functional assessment, medication review, and caregiver needs assessment	A more comprehensive dementia care planning visit that often includes the functional assessment described by `1175F`; billed when care planning and more extensive time/documentation requirements are met
`96116`	Neurobehavioral status exam; administration of a standardized cognitive performance test, interpretation, and report	Cognitive testing that may be performed alongside a functional ADL/IADL assessment to quantify cognition
`99341`	Home visit for established patient, low complexity	Functional assessments may be performed during home visits when the patient cannot attend the clinic
`99490`	Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health professional, per calendar month	Functional status assessments inform chronic care management plans for patients with dementia and support monthly CCM services
`G0505`	Comprehensive assessment of and care planning for patients requiring chronic care management services (Medicare)	Medicare-specific care planning that incorporates functional assessment findings into the chronic care plan

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