CPT 1175F: Functional Assessment for Dementia (ADL/IADL)

CPT code 1175F documents that the provider assesses and reviews a patient’s functional status related to dementia, including evaluation of activities of daily living (ADLs) and/or instrumental activities of daily living (IADLs); service type: functional assessment and care planning, typical site of service: outpatient clinic or office visit.

For related coverage guidance, see recent payer policy updates: Prolonged Services for Labor Management, Prolonged Services for Labor Management, Cervical Cancer Screening.

Customize your policy alerts

Sign up for cpt 1175F policy alerts

Get alerted when payer policies referencing 1175F are released or updated.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Explore openpayer tools

View all tools

CPT 1175F: Functional Assessment for Dementia (ADL/IADL)

For related coverage guidance, see recent payer policy updates: Prolonged Services for Labor Management, Prolonged Services for Labor Management, Cervical Cancer Screening.

Customize your policy alerts

Sign up for cpt 1175F policy alerts

Get alerted when payer policies referencing 1175F are released or updated.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

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.

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

Related Modifiers

6 rows

Modifier	Description	When to Use
25	CPT modifier 25 indicates that on the same day as another procedure or service, the same physician or other qualified health care professional provided a significant, separately identifiable…	- When to apply: Use modifier 25 only on an E/M code to indicate the same provider delivered a significant, separately identifiable E/M service on the same day as another procedure or service — i.e.,…
59	Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…	- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
76	Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…	- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…
77	Modifier 77 indicates that a previously performed procedure or service was legitimately repeated by a different physician or other qualified health care professional. The AMA’s CPT definition…	- Use modifier 77 when a basic procedure or service already performed is repeated by a different physician or other qualified health care professional (for example, a second provider independently…
24	Modifier 24 denotes an unrelated evaluation and management (E/M) service performed by the same physician or qualified healthcare professional during a postoperative global period. Per CPT guidance,…	- Use modifier 24 when you report an evaluation and management (E/M) service performed by the same physician or same-specialty group during a procedure’s postoperative global period that is unrelated…
91	Modifier 91 — “Repeat Clinical Diagnostic Laboratory Test” — is appended when the exact same CPT laboratory test is performed more than once for the same patient on the same day because serial,…	- Use modifier 91 when the exact same CPT laboratory test is performed more than once on the same patient on the same date because serial or repeated testing is medically necessary to monitor…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
207Q00000X	Family Medicine Physician	Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadt…
207L00000X	Anesthesiology Physician	An anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an opera…
207R00000X	Internal Medicine Physician	A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults…
208D00000X	General Practice Physician	A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.
251B00000X	Case Management Agency	An organization that is responsible for providing case management services. The agency provides services which assist an individual in gaining access…
225XP0200X	Pediatric Occupational Therapist	Occupational therapists provide services to infants, toddlers and children who have or who are at risk for developmental delays or disabilities. Occup…
204R00000X	Electrodiagnostic Medicine Physician	Electrodiagnostic medicine is the medical subspecialty that applies neurophysiologic techniques to diagnose, evaluate, and treat patients with impairm…
2251N0400X	Neurology Physical Therapist	A licensed physical therapist, including but not limited to an individual who is a Board Certified Specialist in Neurologic Physical Therapy, who has …

Related Payer Policy Updates

Specialty: Obstetrics/Gynecology1 / 3

10 rows

Policy	Payer	Effective Date
Prolonged Services for Labor Management	Premera Bluecross	2027-01-01
Prolonged Services for Labor Management	Premera Bluecross	2027-01-01
Cervical Cancer Screening	Oscar Health	2026-10-01
Prenatal Testing for Fetal Aneuploidy	Oscar Health	2026-10-01
Diagnosis of Vaginitis	Oscar Health	2026-10-01
Prenatal Screening (Nongenetic)	Oscar Health	2026-10-01
View PDF of Maternal Serum Biomarkers for Prediction of Adverse Obstetric Outcomes, Effective 10/1/2026 in Medical	Blue Cross Blue Shield - Rhode Island	2026-10-01
Maternal Serum Testing for Prediction of Adverse Obstetric Outcomes	Bluecross Idaho	2026-09-01
Ultrasound in Pregnancy (including 3D, 4D and 5D Ultrasound)	Cigna	2026-08-15
Abortion — Treatment of Complications and Coverage Criteria	Cigna	2026-08-08

CPT 1000F: Tobacco Use Status Assessment

CPT-1002F-NO-SUMMARY-AVAILABLE

CPT 1002F: No Summary available

CPT-1003F-PERFORMANCE-MEASURE

CPT 1003F: Preventive Care Tobacco Use Counseling

CPT-1004F-NO-SUMMARY-AVAILABLE

CPT 1004F: Health Status Assessment

CPT-1005F-NO-SUMMARY-AVAILABLE

CPT 1005F: Peripheral Oxygen Saturation Assessment

CPT-1006F-BRIEF-SUMMARY-NOT-AVAILABLE

CPT 1006F: No Summary Available

CPT-1007F-NO-SUMMARY-AVAILABLE

CPT 1007F: Influenza Vaccination Administered

CPT-1008F-UNSPECIFIED-SERVICE

CPT 1008F: Depression Screening, Brief Standardized Assessment

CPT-1010F-ANGINA-SEVERITY-ASSESSMENT-CAD-ACTIVITY-RESPONSE

CPT 1010F: Angina Activity Assessment in Coronary Artery Disease

CPT-1011F-THERAPEUTIC-MANAGEMENT-CORONARY-ARTERY-DISEASE-ANGINA

CPT 1011F: Therapeutic Management for CAD with Angina

Showing 1–10 of 81

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Explore openpayer tools

View all tools

Clinical & Coding Specifications

Clinical Context

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

Related Modifiers

6 rows

Modifier	Description	When to Use
25	CPT modifier 25 indicates that on the same day as another procedure or service, the same physician or other qualified health care professional provided a significant, separately identifiable…	- When to apply: Use modifier 25 only on an E/M code to indicate the same provider delivered a significant, separately identifiable E/M service on the same day as another procedure or service — i.e.,…
59	Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…	- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
76	Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…	- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…
77	Modifier 77 indicates that a previously performed procedure or service was legitimately repeated by a different physician or other qualified health care professional. The AMA’s CPT definition…	- Use modifier 77 when a basic procedure or service already performed is repeated by a different physician or other qualified health care professional (for example, a second provider independently…
24	Modifier 24 denotes an unrelated evaluation and management (E/M) service performed by the same physician or qualified healthcare professional during a postoperative global period. Per CPT guidance,…	- Use modifier 24 when you report an evaluation and management (E/M) service performed by the same physician or same-specialty group during a procedure’s postoperative global period that is unrelated…
91	Modifier 91 — “Repeat Clinical Diagnostic Laboratory Test” — is appended when the exact same CPT laboratory test is performed more than once for the same patient on the same day because serial,…	- Use modifier 91 when the exact same CPT laboratory test is performed more than once on the same patient on the same date because serial or repeated testing is medically necessary to monitor…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
207Q00000X	Family Medicine Physician	Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadt…
207L00000X	Anesthesiology Physician	An anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an opera…
207R00000X	Internal Medicine Physician	A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults…
208D00000X	General Practice Physician	A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.
251B00000X	Case Management Agency	An organization that is responsible for providing case management services. The agency provides services which assist an individual in gaining access…
225XP0200X	Pediatric Occupational Therapist	Occupational therapists provide services to infants, toddlers and children who have or who are at risk for developmental delays or disabilities. Occup…
204R00000X	Electrodiagnostic Medicine Physician	Electrodiagnostic medicine is the medical subspecialty that applies neurophysiologic techniques to diagnose, evaluate, and treat patients with impairm…
2251N0400X	Neurology Physical Therapist	A licensed physical therapist, including but not limited to an individual who is a Board Certified Specialist in Neurologic Physical Therapy, who has …

Related Payer Policy Updates

Specialty: Obstetrics/Gynecology1 / 3

10 rows

Policy	Payer	Effective Date
Prolonged Services for Labor Management	Premera Bluecross	2027-01-01
Prolonged Services for Labor Management	Premera Bluecross	2027-01-01
Cervical Cancer Screening	Oscar Health	2026-10-01
Prenatal Testing for Fetal Aneuploidy	Oscar Health	2026-10-01
Diagnosis of Vaginitis	Oscar Health	2026-10-01
Prenatal Screening (Nongenetic)	Oscar Health	2026-10-01
View PDF of Maternal Serum Biomarkers for Prediction of Adverse Obstetric Outcomes, Effective 10/1/2026 in Medical	Blue Cross Blue Shield - Rhode Island	2026-10-01
Maternal Serum Testing for Prediction of Adverse Obstetric Outcomes	Bluecross Idaho	2026-09-01
Ultrasound in Pregnancy (including 3D, 4D and 5D Ultrasound)	Cigna	2026-08-15
Abortion — Treatment of Complications and Coverage Criteria	Cigna	2026-08-08

CPT 1000F: Tobacco Use Status Assessment

CPT-1002F-NO-SUMMARY-AVAILABLE

CPT 1002F: No Summary available

CPT-1003F-PERFORMANCE-MEASURE

CPT 1003F: Preventive Care Tobacco Use Counseling

CPT-1004F-NO-SUMMARY-AVAILABLE

CPT 1004F: Health Status Assessment

CPT-1005F-NO-SUMMARY-AVAILABLE

CPT 1005F: Peripheral Oxygen Saturation Assessment

CPT-1006F-BRIEF-SUMMARY-NOT-AVAILABLE

CPT 1006F: No Summary Available

CPT-1007F-NO-SUMMARY-AVAILABLE

CPT 1007F: Influenza Vaccination Administered

CPT-1008F-UNSPECIFIED-SERVICE

CPT 1008F: Depression Screening, Brief Standardized Assessment

CPT-1010F-ANGINA-SEVERITY-ASSESSMENT-CAD-ACTIVITY-RESPONSE

CPT 1010F: Angina Activity Assessment in Coronary Artery Disease

CPT-1011F-THERAPEUTIC-MANAGEMENT-CORONARY-ARTERY-DISEASE-ANGINA

CPT 1011F: Therapeutic Management for CAD with Angina

Showing 1–10 of 81

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

OpenPayer

CPT 1175F: Functional Assessment for Dementia (ADL/IADL)

Sign up for cpt 1175F policy alerts

OpenPayer

CPT 1175F: Functional Assessment for Dementia (ADL/IADL)

Sign up for cpt 1175F policy alerts

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Payer Policy Updates

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Payer Policy Updates

Related Codes

References

CPT 1175F: Functional Assessment for Dementia (ADL/IADL)

Sign up for cpt 1175F policy alerts

CPT 1175F: Functional Assessment for Dementia (ADL/IADL)

Sign up for cpt 1175F policy alerts

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Payer Policy Updates

Related Codes

What does CPT 1175F represent and where is it typically used?

What clinical information and documentation support use of 1175F?

How does 1175F relate to other CPT codes like 99483, 96116, or chronic care management codes?

Which modifiers and payer workflow indicators are noted for use with 1175F?

Does the page provide payer coverage details or reimbursement rates for 1175F?

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Payer Policy Updates

Related Codes

What does CPT 1175F represent and where is it typically used?

What clinical information and documentation support use of 1175F?

How does 1175F relate to other CPT codes like 99483, 96116, or chronic care management codes?

Which modifiers and payer workflow indicators are noted for use with 1175F?

Does the page provide payer coverage details or reimbursement rates for 1175F?

References