Reminder: Proper Depression Screening Coding
Date: 01/13/25
Depression screening and follow-up visits for adolescents and adults is a key part of HEDIS®/CMS Core Set measures for our Commercial, Marketplace, Medicaid, and Medicare lines of business. Proper coding of these measures (DSF-E, CDF-AD, or CDF-CH) means that any open gaps in care will be closed.
- Depression Screening and Follow-Up for Adolescents and Adults (DSF-E) pertains to members 12 years of age and older who were screened for clinical depression using a standardized instrument and, if screened positive, received follow-up care. (HEDIS®)
- Screening for Depression and Follow-Up Plan: Age 12 and Older (CDF) pertains to members 12 years of age and older who were screened for depression on the date of the encounter or 14 days prior to the date of the encounter using an age-appropriate standardized depression screening tool, and, if positive, a follow-up plan is documented on the date of the qualifying encounter. (CMS Core Set)
These measures are closed through Administrative Gap Closure by using a combination of LOINC, HCPCS, CPT, and CPT II claims as applicable.
Two rates are reported for these measures:
- Depression Screening: Members who were screened for clinical depression using a standardized instrument. Must report applicable LOINC screening code and HCPCS documentation code for gap closure.
- Follow-Up on Positive Screening: Members who received follow-up care within 30 days of a positive depression screen finding.
The following codes should be billed on all claims and encounters when applicable: To support you, Arkansas Total Care will pay $0.01 for the HCPCS codes below. This will allow you to bill for these services without getting a denial for non-payable codes.
HCPCS codes to document depression screening
G8431 | Screening for depression is documented as being positive, and a follow-up plan is documented. |
G8510 | Screening for depression is documented as negative, and a follow-up plan is not required. |
Depression Screening Instrument Coding
Instruments for Adolescents (<17 years) | Total Score *LOINC Codes | Positive Finding |
|---|---|---|
Patient Health Questionnaire (PHQ-9)® | 44261-6 | Total score ≥10 |
Patient Health Questionnaire Modified for Teens (PHQ-9M)® | 89204-2 | Total score ≥10 |
Patient Health Questionnaire-2 (PHQ-2)®[1] | 55758-7 | Total score ≥3 |
Beck Depression Inventory-Fast Screen (BDI-FS)®1, [2] | 89208-3 | Total score ≥8 |
Center for Epidemiologic Studies Depression Scale—Revised (CESD-R) | 89205-9 | Total score ≥17 |
Edinburgh Postnatal Depression Scale (EPDS) | 71354-5 | Total score ≥10 |
PROMIS Depression | 71965-8 | Total score (T Score) ≥60 |
Instruments for Adults (18+ years) | Total Score LOINC Codes | Positive Finding |
Patient Health Questionnaire (PHQ-9)® | 44261-6 | Total score ≥10 |
Patient Health Questionnaire-2 (PHQ-2)® | 55758-7 | Total score ≥3 |
Beck Depression Inventory-Fast Screen (BDI-FS)®1,2 | 89208-3 | Total score ≥8 |
Beck Depression Inventory (BDI-II) | 89209-1 | Total score ≥20 |
Center for Epidemiologic Studies Depression Scale—Revised (CESD-R) | 89205-9 | Total score ≥17 |
Duke Anxiety—Depression Scale (DUKE-AD)®2 | 90853-3 | Total score ≥30 |
Instruments for Adults (18+ years) continued | Total Score LOINC Codes | Positive Finding |
Geriatric Depression Scale Short Form (GDS)1 | 48545-8 | Total score ≥5 |
Geriatric Depression Scale Long Form (GDS) | 48544-1 | Total score ≥10 |
Edinburgh Postnatal Depression Scale (EPDS) | 48544-1 | Total score ≥10 |
My Mood Monitor (M-3)® | 71777-7 | Total score ≥5 |
PROMIS Depression | 71965-8 | Total score (T Score) ≥60 |
Clinically Useful Depression Outcome Scale (CUDOS) | 90221-3 | Total score ≥31 |
Follow-Up on Positive Screen Coding
CPT® Codes | HCPCS Codes |
|---|---|
90791, 90792, 90832-90834, 90836-90839, 90846, 90849, 90853, 90870, 90887, 99202-99205, 99211-99215, 99242-99245, 99341, 99342, 99345, 99347-99350, 99381-99385, 99391-99395, 99401-99402 | G2012, H0034, H0035, H2000, H2011-H2017, H2019, H2020, T1015-T1017, T2022 |
- Follow-up on positive screen on same day or 30 days after the first positive screen.
- An outpatient, telephone, e-visit, or virtual check-in follow-up visit with a diagnosis of depression or other behavioral health condition — as long as it is a Medicaid payable code identified above.
- A behavioral health encounter, including assessment, therapy, collaborative care, or medication management.
- A dispensed antidepressant medication OR documentation of additional depression screening on a full-length instrument indicating either no depression or no symptoms that require follow-up (i.e., a negative screen) on the same day as a positive screen on a brief screening instrument. For example, if there is a positive screen resulting from a PHQ-2 score, documentation of a negative finding from a PHQ-9 performed on the same day qualifies as evidence of follow-up.
For more information about these and other quality measures, visit our For Providers page.
[1] Brief screening instrument. All other instruments are full-length.
[2] Proprietary; may be cost or licensing requirement associated with use.