The cognitive test is not mandatory for Medicare beneficiaries, but it is an included feature of the Medicare Annual Wellness Visit (AWV). A cognitive assessment is a screening tool used to check for changes in memory and thinking abilities, which can be an early indicator of conditions like dementia. Medicare Part B covers this preventive service, reflecting a focus on early detection and intervention for cognitive impairment. The following sections clarify the policy context of this screening and the steps that follow concerning results.
The Annual Wellness Visit: Context for Cognitive Screening
The cognitive screening is a required component of the Medicare Annual Wellness Visit (AWV), which is itself a voluntary service for the beneficiary. A person is not required to take a cognitive assessment unless they choose to participate in the AWV or if their physician has specific concerns about their memory. The AWV is a yearly visit focused on prevention and developing a personalized prevention plan, not a full physical examination.
The provider must assess the patient’s cognitive function, often through a combination of direct observation, patient report, and information gathered from family or caregivers. Since the AWV is entirely optional, the cognitive screening within it is not mandatory for all Medicare enrollees.
Tools Used During Cognitive Assessment
The purpose of the cognitive assessment during the AWV is to identify potential concerns, not to provide a definitive diagnosis. This screening is typically brief, non-invasive, and can be administered quickly by a primary care provider or qualified staff. The Centers for Medicare & Medicaid Services (CMS) does not mandate a single specific tool, allowing providers flexibility to choose the best option.
Common tools used for this initial screening include:
- The Mini-Cog
- The Memory Impairment Screen (MIS)
- The General Practitioner Assessment of Cognition (GPCOG)
- The St. Louis University Mental Status Exam (SLUMS)
- The Montreal Cognitive Assessment (MoCA)
These tools help confirm initial findings before making a referral.
Next Steps Following a Positive Screening Result
If the brief screening performed during the AWV indicates a potential cognitive impairment, it serves as a starting point for a more thorough investigation. Medicare Part B covers a separate, more comprehensive visit specifically for a full cognitive assessment and care plan development. This detailed service is designed to establish or confirm a diagnosis, such as dementia or Alzheimer’s disease.
The comprehensive assessment includes a detailed history, often requiring an independent historian like a family member or caregiver, since the patient may not be able to provide a reliable history. Key elements involve a functional assessment of daily living activities, a review and reconciliation of all medications for high-risk interactions, and an evaluation of neuropsychiatric symptoms like depression or anxiety.
Following this extensive evaluation, a written care plan is created. This plan includes initial strategies to address functional limitations and a referral to specialists such as neurologists or geriatric specialists. The care plan also involves identifying caregiver needs, a safety evaluation for home and driving, and developing or reviewing an Advance Care Plan. For this follow-up assessment and care planning service, the Part B deductible and a 20% coinsurance apply.