Dementia staging: FAST vs CDR
Staging places a patient’s dementia on a severity scale, which shapes the care plan and is a required element of CPT 99483. The FAST and the CDR are the two staging instruments the code most commonly relies on.
FAST (Functional Assessment Staging Tool)
FAST describes seven stages based on functional decline, from no difficulty through to severe impairment. It is functional and observational, widely used in Alzheimer’s disease, and its more advanced stages feature in hospice-eligibility considerations.
CDR (Clinical Dementia Rating)
The CDR rates six domains to a global score: 0 (none), 0.5 (questionable / very mild), 1 (mild), 2 (moderate), and 3 (severe). It draws on both the patient and an informant, and the domain boxes can also be summed for a finer measure.
Which to use, and how to document it
Either is acceptable as a standardized staging instrument. The essential part is the result: record the instrument used and the resulting stage or score with a date. A staging instrument named without a documented stage is a common review finding.
Where this fits in CPT 99483
Dementia staging with a standardized instrument is one of the nine required assessment elements of 99483. Note that a cognitive screen such as the MoCA or MMSE is not itself the staging instrument — the code expects a standardized staging tool (FAST or CDR) in addition to any cognition-detection test.
Frequently asked questions
Does CPT 99483 require dementia staging?
Yes. A standardized instrument for dementia staging — for example the FAST or the CDR — together with its result is one of the required assessment elements.
What is the difference between FAST and CDR?
FAST stages by functional decline across seven stages; the CDR rates six cognitive/functional domains to a global 0–3 score. Either can serve as the standardized staging instrument.
Is the MoCA a dementia staging instrument?
No. The MoCA (and the MMSE and Mini-Cog) are cognition-detection screens, not staging instruments. CPT 99483 requires a standardized staging tool such as the FAST or CDR in addition.
What do I document for staging?
Record the staging instrument used and the resulting stage or score with the date — the result, not just the instrument’s name.
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