Montreal Cognitive Assessment (MoCA) 

The Montreal Cognitive Assessment (MoCA) is a roughly 10-minute, clinician-administered global cognitive screen covering visuospatial/executive function, naming, memory, attention, language, abstraction, delayed recall, and orientation. It is scored 0–30, with a commonly cited (though contested) screening cutoff around 26, and is used to flag possible mild cognitive impairment for further workup — not to diagnose it.

What the MoCA Measures

The MoCA samples eight cognitive domains in a single short-form instrument, which is what distinguishes it from single-domain tests like Trail Making Test A or Digit Span:

• Visuospatial/executive function — trail-making-style connect-the-dots task, cube copy, clock draw
• Naming — confrontation naming of low-familiarity animals
• Memory — two learning trials of a 5-word list, with delayed free recall later in the test
• Attention — digit span forward/backward, target detection (tapping), serial subtraction
• Language — sentence repetition, letter (F) fluency
• Abstraction — similarities between paired words
• Delayed recall — free recall of the 5-word list from the memory trial
• Orientation — date, month, year, day, place, city

Because it samples this many domains in one pass, the MoCA functions as a broad "is something wrong here" screen rather than a domain-specific diagnostic instrument. When a specific domain flags — memory, processing speed, executive function — that typically prompts referral to a fuller battery covering memory, processing speed, or executive function in more depth.

Administration Time

Roughly 10 minutes for a trained administrator to deliver and score, making it fast enough to use as an in-visit or between-visit clinician-administered check rather than requiring a separate full neuropsych appointment. This brevity is central to its role in concussion and post-injury cognitive-health workflows, where a full multi-hour neuropsych battery is often reserved for cases that don't resolve as expected.

Scoring and Interpretation

Total raw score ranges from 0–30. One point is added to the raw score for individuals with 12 years of education or fewer, per the original validation protocol, to correct for education-related scoring bias.

The score most commonly cited in clinical use — and in the instrument's original 2005 validation study — is that a total score below 26 is suggestive of possible mild cognitive impairment (MCI) warranting further evaluation. This threshold should be treated as a commonly used screening cutoff, not a fixed diagnostic line. Later psychometric work examining the MoCA's classification statistics has found that a single cutoff can over-flag impairment in cognitively normal, lower-education populations and under-detect impairment in highly educated individuals whose baseline performance sits well above the cutoff even with meaningful decline. Some clinical populations (for example Parkinson's disease or stroke recovery) are commonly assessed against different, population-specific thresholds in the literature rather than the general-population cutoff.

For this reason, many clinicians interpret the MoCA as a screening signal that should be read alongside age, education, and — where available — the patient's own prior scores, rather than as a single pass/fail line. A single low score is a prompt to look closer, not a diagnosis; serial MoCA administration to track a trend within one patient is generally more clinically informative than any single cross-sectional score.

Further reading: Montreal Cognitive Assessment — RehabMeasures Database (opens in a new tab); Classification statistics of the MoCA: Are we interpreting the MoCA correctly? (PMC) (opens in a new tab).

Clinical Use Case

In concussion and cognitive-health practice, the MoCA is most useful as a global-cognition check when a patient's presentation goes beyond typical concussion symptom recovery — for example, when persistent post-concussive symptoms include cognitive complaints that don't track cleanly with the concussion-specific tools in a standard protocol, or when a clinician wants a fast baseline read before deciding whether to escalate to full neurocognitive testing. It is also widely used outside concussion care as a general screen for MCI of unclear cause in aging, post-illness, and post-treatment populations — including chemotherapy-related cognitive change, menopause-related cognitive change, and post-cardiac cognitive decline.

The MoCA is a screen, not a substitute for a full neuropsychological evaluation. A below-cutoff or declining score is generally a trigger to consider referral for more comprehensive testing — see when to refer for neuropsych testing — rather than an endpoint finding on its own.

Billing: Which CPT Code Covers the MoCA

Because the MoCA is typically administered directly by the clinician (or a supervised technician under applicable rules) as a brief, single-pass status exam rather than as part of a multi-instrument technician battery, it is generally not billed under the 96136–96139 test-administration codes the way longer neuropsych batteries are. Instead, coding generally depends on who delivers it and how:

• 96116/96121 (96121) — Neurobehavioral status exam by a physician or qualified health care professional, first hour and each additional 30 minutes, when the clinician personally administers and interprets the MoCA as part of a face-to-face cognitive status exam.
• 96146 — Automated administration and scoring, when a computerized or self-administered version of the MoCA is used and scored electronically, independent of a separate E/M-billed exam.

Neither of these is a guarantee of reimbursement, and the correct code depends on documentation, who performed the exam, and payer-specific policy — see the CMS billing and coding article on psychological and neuropsychological testing (opens in a new tab) for current guidance.

This page provides general educational information about CPT and RTM billing codes. It is not coding advice, a guarantee of reimbursement, or a substitute for your own compliance review. Payer coverage and documentation requirements vary by plan and can change — verify current requirements with CMS, your Medicare Administrative Contractor, and each payer before billing.

Where the MoCA Sits in the Kavera Protocol

The MoCA is one of the instruments available within Kavera's assessment battery, used selectively when a patient's presentation calls for a global cognitive screen alongside the concussion-, mood-, and sleep-focused instruments in the core protocol. It sits primarily within the Cognitive Health module, and is also relevant to the Concussion module when persistent cognitive complaints prompt a broader look than concussion-specific tools like PCSS or SAC provide on their own.

How Kavera Handles This

MoCA anchors the Cognitive Health module at the first visit and re-evaluation. Kavera stores the total and domain subscores so the between-visit cognitive tests (Trail Making, SDMT, Digit Span) are read against a formal baseline. The administration record supports 96116 or 96132 documentation depending on the encounter. Self-Serve practices run this with their own staff. On Managed, Juliet Mott's team runs it and bills it under your credentials.

FAQ

What score on the MoCA suggests a problem?

A total score below 26 out of 30 is the cutoff most commonly cited in the literature as suggestive of possible mild cognitive impairment, but this single threshold is increasingly treated as a rough screening signal rather than a fixed diagnostic line, particularly for patients with lower or higher education levels than the original validation sample.

How is the MoCA different from the MMSE?

Both are brief global cognitive screens, but the MoCA places relatively more emphasis on executive function, attention, and delayed recall, and is generally considered more sensitive to milder cognitive impairment than the Mini-Mental State Examination. Neither test is diagnostic on its own.

Can the MoCA be used to evaluate concussion?

The MoCA is not a concussion-specific instrument — tools like SAC and PCSS are more commonly used for acute and short-term concussion tracking. The MoCA is more often used when a clinician wants to screen for broader cognitive impairment that extends beyond typical concussion recovery.

Does a normal MoCA score rule out cognitive impairment?

No. As a brief screen, the MoCA can miss subtle or single-domain deficits, particularly in highly educated patients whose baseline performance is strong enough to score above cutoff despite meaningful decline. A normal score does not replace clinical judgment or, where indicated, referral for full neuropsychological testing.

Who can administer the MoCA for billing purposes?

Administration and interpretation requirements depend on which CPT code is used and the applicable payer policy — see 96116 and 96121 for the physician/QHP-administered status exam codes, and consult supervision rules for technician-administered testing where relevant.