Summary & Overview
HCPCS M1476: Cognitive Impairment and Alzheimer's Disease Services
HCPCS Level II code M1476 identifies services for patients with cognitive impairment or Alzheimer’s disease and signals care focused on assessment, monitoring, and coordination for cognitive disorders. Nationally, this code matters because cognitive impairment is a growing public health concern with implications for care delivery, care coordination, and resource allocation across outpatient and specialty settings.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for M1476, typical sites of service where it is billed, and what payers commonly consider when covering cognitive care services. The publication provides benchmarks and policy-relevant details to help billing, clinical, and administrative staffs understand where this code fits into care workflows and payer coverage patterns.
The report covers benchmarks for utilization and reimbursement where available, recent policy updates affecting cognitive and Alzheimer’s-related services, and practical considerations for documenting services tied to M1476. It also outlines clinical context—why standardized coding for cognitive impairment matters for quality measurement, care coordination, and longitudinal patient management. Data not available in the input will be explicitly noted in relevant sections.
Billing Code Overview
HCPCS Level II code M1476 denotes services provided to patients with a diagnosis of cognitive impairment or Alzheimer's disease. The code applies to clinical activities tied to cognitive care needs, including assessment, care coordination, and services focused on cognitive impairment management.
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Service type: Cognitive impairment and Alzheimer's disease–focused clinical services (assessment, monitoring, care coordination)
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Typical site of service: Outpatient clinics, specialty memory clinics, neurology practices, geriatrics clinics, and other ambulatory care settings
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Clinical & Coding Specifications
Clinical Context
A typical patient is an older adult referred to a memory clinic or primary care practice for evaluation and management of cognitive decline. The patient presents with progressive memory loss, difficulty with instrumental activities of daily living, and a caregiver report of worsening short-term memory over 12–24 months. Initial visit includes focused history, medication review, cognitive screening (e.g., MoCA or MMSE), functional assessment, and discussion of safety and advance care planning. Diagnostic workflow frequently involves baseline labs (thyroid function, B12), neuroimaging (non-contrast CT or MRI of the brain), and possible neuropsychological testing. Ongoing care includes medication management for symptomatic therapies, caregiver education, supervision planning, and periodic cognitive monitoring every 3–12 months. Typical sites of service are outpatient clinic, memory disorder center, or skilled nursing facility for evaluation or follow-up. Typical modifiers applied depend on the billing circumstances such as multiple procedures, place of service distinctions, or professional vs technical components.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure | Use when an E/M visit is performed the same day as a cognitive assessment or minor procedure and documentation supports a separate service |