Preventive Care and Screening: Screening for Depression and Follow-Up Plan (2022)
| eCQMs / NQF #: | CMS2v11 / XXXX |
| Measure: | Percentage of patients aged 12 years and older screened for depression on the date of the encounter or up to 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 eligible encounter. |
| Numerator: | Patients screened for depression on the date of the encounter or up to 14 days prior to the date of the encounter using an age-appropriate standardized tool AND if positive, a follow-up plan is documented on the date of the eligible encounter. |
| Denominator: | All patients aged 12 years and older at the beginning of the measurement period with at least one eligible encounter during the measurement period. |
| Denominator Exclusion: | Patients who have been diagnosed with depression or with bipolar disorder. |
| Denominator Exception: | Patient Reason(s)
Patient refuses to participate OR Medical Reason(s) Documentation of medical reason for not screening patient for depression (e.g., cognitive, functional, or motivational limitations that may impact accuracy of results; patient is in an urgent or emergent situation where time is of the essence and to delay treatment would jeopardize the patient’s health status). |
| Domain: | Community/Population Health |
In ChartMaker Clinical:
In order to qualify for this measure, the patient must be at least 12 years of age or older and have the appropriate information documented in the chart:
Required Data Elements for the Denominator:
This is captured by adding a procedure with a valid CPT/HCPCS or SNOMED code using the Procedure widget in a note.
| CPT: | |
| Code | Description |
| 59400 | Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartum care |
| 59510 | Routine obstetric care including antepartum care, cesarean delivery, and postpartum care |
| 59610 | Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartum care, after previous cesarean delivery |
| 59618 | Routine obstetric care including antepartum care, cesarean delivery, and postpartum care, following attempted vaginal delivery after previous cesarean delivery |
| 90791 | Psychiatric diagnostic evaluation |
| 90792 | Psychiatric diagnostic evaluation with medical services |
| 90832 | Psychotherapy, 30 minutes with patient |
| 90834 | Psychotherapy, 45 minutes with patient |
| 90837 | Psychotherapy, 60 minutes with patient |
| 92625 | Assessment of tinnitus (includes pitch, loudness matching, and masking) |
| 96105 | Assessment of aphasia (includes assessment of expressive and receptive speech and language function, language comprehension, speech production ability, reading, spelling, writing, eg, by Boston Diagnostic Aphasia Examination) with interpretation and report, per hour |
| 96110 | Developmental screening (eg, developmental milestone survey, speech and language delay screen), with scoring and documentation, per standardized instrument |
| 96112 | Developmental test administration (including assessment of fine and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments when performed), by physician or other qualified health care professional, with interpretation and report; first hour |
| 96116 | Neurobehavioral status exam (clinical assessment of thinking, reasoning and judgment, [eg, acquired knowledge, attention, language, memory, planning and problem solving, and visual spatial abilities]), by physician or other qualified health care professional, both face-to-face time with the patient and time interpreting test results and preparing the report; first hour |
| 96125 | Standardized cognitive performance testing (eg, Ross Information Processing Assessment) per hour of a qualified health care professional’s time, both face-to-face time administering tests to the patient and time interpreting these test results and preparing the report |
| 96136 | Psychological or neuropsychological test administration and scoring by physician or other qualified health care professional, two or more tests, any method; first 30 minutes |
| 96138 | Psychological or neuropsychological test administration and scoring by technician, two or more tests, any method; first 30 minutes |
| 96156 | Health behavior assessment, or re-assessment (ie, health-focused clinical interview, behavioral observations, clinical decision making) |
| 96158 | Health behavior intervention, individual, face-to-face; initial 30 minutes |
| 97161 | Physical therapy evaluation: low complexity, requiring these components: A history with no personal factors and/or comorbidities that impact the plan of care; An examination of body system(s) using standardized tests and measures addressing 1-2 elements from any of the following: body structures and functions, activity limitations, and/or participation restrictions; A clinical presentation with stable and/or uncomplicated characteristics; and Clinical decision making of low complexity using standardized patient assessment instrument and/or measurable assessment of functional outcome. Typically, 20 minutes are spent face-to-face with the patient and/or family. |
| 97162 | Physical therapy evaluation: moderate complexity, requiring these components: A history of present problem with 1-2 personal factors and/or comorbidities that impact the plan of care; An examination of body systems using standardized tests and measures in addressing a total of 3 or more elements from any of the following: body structures and functions, activity limitations, and/or participation restrictions; An evolving clinical presentation with changing characteristics; and Clinical decision making of moderate complexity using standardized patient assessment instrument and/or measurable assessment of functional outcome. Typically, 30 minutes are spent face-to-face with the patient and/or family. |
| 97163 | Physical therapy evaluation: high complexity, requiring these components: A history of present problem with 3 or more personal factors and/or comorbidities that impact the plan of care; An examination of body systems using standardized tests and measures addressing a total of 4 or more elements from any of the following: body structures and functions, activity limitations, and/or participation restrictions; A clinical presentation with unstable and unpredictable characteristics; and Clinical decision making of high complexity using standardized patient assessment instrument and/or measurable assessment of functional outcome. Typically, 45 minutes are spent face-to-face with the patient and/or family. |
| 97165 | Occupational therapy evaluation, low complexity, requiring these components: An occupational profile and medical and therapy history, which includes a brief history including review of medical and/or therapy records relating to the presenting problem; An assessment(s) that identifies 1-3 performance deficits (ie, relating to physical, cognitive, or psychosocial skills) that result in activity limitations and/or participation restrictions; and Clinical decision making of low complexity, which includes an analysis of the occupational profile, analysis of data from problem-focused assessment(s), and consideration of a limited number of treatment options. Patient presents with no comorbidities that affect occupational performance. Modification of tasks or assistance (eg, physical or verbal) with assessment(s) is not necessary to enable completion of evaluation component. Typically, 30 minutes are spent face-to-face with the patient and/or family. |
| 97166 | Occupational therapy evaluation, moderate complexity, requiring these components: An occupational profile and medical and therapy history, which includes an expanded review of medical and/or therapy records and additional review of physical, cognitive, or psychosocial history related to current functional performance; An assessment(s) that identifies 3-5 performance deficits (ie, relating to physical, cognitive, or psychosocial skills) that result in activity limitations and/or participation restrictions; and Clinical decision making of moderate analytic complexity, which includes an analysis of the occupational profile, analysis of data from detailed assessment(s), and consideration of several treatment options. Patient may present with comorbidities that affect occupational performance. Minimal to moderate modification of tasks or assistance (eg, physical or verbal) with assessment(s) is necessary to enable patient to complete evaluation component. Typically, 45 minutes are spent face-to-face with the patient and/or family. |
| 97167 | Occupational therapy evaluation, high complexity, requiring these components: An occupational profile and medical and therapy history, which includes review of medical and/or therapy records and extensive additional review of physical, cognitive, or psychosocial history related to current functional performance; An assessment(s) that identifies 5 or more performance deficits (ie, relating to physical, cognitive, or psychosocial skills) that result in activity limitations and/or participation restrictions; and Clinical decision making of high analytic complexity, which includes an analysis of the patient profile, analysis of data from comprehensive assessment(s), and consideration of multiple treatment options. Patient presents with comorbidities that affect occupational performance. Significant modification of tasks or assistance (eg, physical or verbal) with assessment(s) is necessary to enable patient to complete evaluation component. Typically, 60 minutes are spent face-to-face with the patient and/or family. |
| 99078 | Physician or other qualified health care professional qualified by education, training, licensure/regulation (when applicable) educational services rendered to patients in a group setting (eg, prenatal, obesity, or diabetic instructions) |
| 99202 | Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using time for code selection, 15-29 minutes of total time is spent on the date of the encounter. |
| 99203 | Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using time for code selection, 30-44 minutes of total time is spent on the date of the encounter. |
| 99204 | Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using time for code selection, 45-59 minutes of total time is spent on the date of the encounter. |
| 99205 | Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 60-74 minutes of total time is spent on the date of the encounter. |
| 99212 | Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using time for code selection, 10-19 minutes of total time is spent on the date of the encounter. |
| 99213 | Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using time for code selection, 20-29 minutes of total time is spent on the date of the encounter. |
| 99214 | Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using time for code selection, 30-39 minutes of total time is spent on the date of the encounter. |
| 99215 | Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 40-54 minutes of total time is spent on the date of the encounter. |
| 99304 | Initial nursing facility care, per day, for the evaluation and management of a patient, which requires these 3 key components: A detailed or comprehensive history; A detailed or comprehensive examination; and Medical decision making that is straightforward or of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the problem(s) requiring admission are of low severity. Typically, 25 minutes are spent at the bedside and on the patient’s facility floor or unit. |
| 99305 | Initial nursing facility care, per day, for the evaluation and management of a patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the problem(s) requiring admission are of moderate severity. Typically, 35 minutes are spent at the bedside and on the patient’s facility floor or unit. |
| 99306 | Initial nursing facility care, per day, for the evaluation and management of a patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the problem(s) requiring admission are of high severity. Typically, 45 minutes are spent at the bedside and on the patient’s facility floor or unit. |
| 99307 | Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: A problem focused interval history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the patient is stable, recovering, or improving. Typically, 10 minutes are spent at the bedside and on the patient’s facility floor or unit. |
| 99308 | Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the patient is responding inadequately to therapy or has developed a minor complication. Typically, 15 minutes are spent at the bedside and on the patient’s facility floor or unit. |
| 99309 | Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: A detailed interval history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the patient has developed a significant complication or a significant new problem. Typically, 25 minutes are spent at the bedside and on the patient’s facility floor or unit. |
| 99310 | Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: A comprehensive interval history; A comprehensive examination; Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. The patient may be unstable or may have developed a significant new problem requiring immediate physician attention. Typically, 35 minutes are spent at the bedside and on the patient’s facility floor or unit. |
| 99315 | Nursing facility discharge day management; 30 minutes or less |
| 99316 | Nursing facility discharge day management; more than 30 minutes |
| 99318 | Evaluation and management of a patient involving an annual nursing facility assessment, which requires these 3 key components: A detailed interval history; A comprehensive examination; and Medical decision making that is of low to moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the patient is stable, recovering, or improving. Typically, 30 minutes are spent at the bedside and on the patient’s facility floor or unit. |
| 99324 | Domiciliary or rest home visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; and Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem(s) are of low severity. Typically, 20 minutes are spent with the patient and/or family or caregiver. |
| 99325 | Domiciliary or rest home visit for the evaluation and management of a new patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; and Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem(s) are of moderate severity. Typically, 30 minutes are spent with the patient and/or family or caregiver. |
| 99326 | Domiciliary or rest home visit for the evaluation and management of a new patient, which requires these 3 key components: A detailed history; A detailed examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 45 minutes are spent with the patient and/or family or caregiver. |
| 99327 | Domiciliary or rest home visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem(s) are of high severity. Typically, 60 minutes are spent with the patient and/or family or caregiver. |
| 99328 | Domiciliary or rest home visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the patient is unstable or has developed a significant new problem requiring immediate physician attention. Typically, 75 minutes are spent with the patient and/or family or caregiver. |
| 99334 | Domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A problem focused interval history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem(s) are self-limited or minor. Typically, 15 minutes are spent with the patient and/or family or caregiver. |
| 99335 | Domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem(s) are of low to moderate severity. Typically, 25 minutes are spent with the patient and/or family or caregiver. |
| 99336 | Domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A detailed interval history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 40 minutes are spent with the patient and/or family or caregiver. |
| 99337 | Domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A comprehensive interval history; A comprehensive examination; Medical decision making of moderate to high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem(s) are of moderate to high severity. The patient may be unstable or may have developed a significant new problem requiring immediate physician attention. Typically, 60 minutes are spent with the patient and/or family or caregiver. |
| 99339 | Individual physician supervision of a patient (patient not present) in home, domiciliary or rest home (eg, assisted living facility) requiring complex and multidisciplinary care modalities involving regular physician development and/or revision of care plans, review of subsequent reports of patient status, review of related laboratory and other studies, communication (including telephone calls) for purposes of assessment or care decisions with health care professional(s), family member(s), surrogate decision maker(s) (eg, legal guardian) and/or key caregiver(s) involved in patient’s care, integration of new information into the medical treatment plan and/or adjustment of medical therapy, within a calendar month; 15-29 minutes |
| 99340 | Individual physician supervision of a patient (patient not present) in home, domiciliary or rest home (eg, assisted living facility) requiring complex and multidisciplinary care modalities involving regular physician development and/or revision of care plans, review of subsequent reports of patient status, review of related laboratory and other studies, communication (including telephone calls) for purposes of assessment or care decisions with health care professional(s), family member(s), surrogate decision maker(s) (eg, legal guardian) and/or key caregiver(s) involved in patient’s care, integration of new information into the medical treatment plan and/or adjustment of medical therapy, within a calendar month; 30 minutes or more |
| 99384 | Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; adolescent (age 12 through 17 years) |
| 99385 | Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 18-39 years |
| 99386 | Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 40-64 years |
| 99387 | Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 65 years and older |
| 99394 | Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; adolescent (age 12 through 17 years) |
| 99395 | Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 18-39 years |
| 99396 | Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 40-64 years |
| 99397 | Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 65 years and older |
| 99401 | Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 15 minutes |
| 99402 | Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 30 minutes |
| 99403 | Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 45 minutes |
| 99404 | Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 60 minutes |
| 99483 | Assessment of and care planning for a patient with cognitive impairment, requiring an independent historian, in the office or other outpatient, home or domiciliary or rest home, with all of the following required elements: Cognition-focused evaluation including a pertinent history and examination; Medical decision making of moderate or high complexity; Functional assessment (eg, basic and instrumental activities of daily living), including decision-making capacity; Use of standardized instruments for staging of dementia (eg, functional assessment staging test [FAST], clinical dementia rating [CDR]); Medication reconciliation and review for high-risk medications; Evaluation for neuropsychiatric and behavioral symptoms, including depression, including use of standardized screening instrument(s); Evaluation of safety (eg, home), including motor vehicle operation; Identification of caregiver(s), caregiver knowledge, caregiver needs, social supports, and the willingness of caregiver to take on caregiving tasks; Development, updating or revision, or review of an Advance Care Plan; Creation of a written care plan, including initial plans to address any neuropsychiatric symptoms, neuro-cognitive symptoms, functional limitations, and referral to community resources as needed (eg, rehabilitation services, adult day programs, support groups) shared with the patient and/or caregiver with initial education and support. Typically, 50 minutes are spent face-to-face with the patient and/or family or caregiver. |
| 99484 | Care management services for behavioral health conditions, at least 20 minutes of clinical staff time, directed by a physician or other qualified health care professional, per calendar month, with the following required elements: initial assessment or follow-up monitoring, including the use of applicable validated rating scales; behavioral health care planning in relation to behavioral/psychiatric health problems, including revision for patients who are not progressing or whose status changes; facilitating and coordinating treatment such as psychotherapy, pharmacotherapy, counseling and/or psychiatric consultation; and continuity of care with a designated member of the care team. |
| 99492 | Initial psychiatric collaborative care management, first 70 minutes in the first calendar month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional, with the following required elements: outreach to and engagement in treatment of a patient directed by the treating physician or other qualified health care professional; initial assessment of the patient, including administration of validated rating scales, with the development of an individualized treatment plan; review by the psychiatric consultant with modifications of the plan if recommended; entering patient in a registry and tracking patient follow-up and progress using the registry, with appropriate documentation, and participation in weekly caseload consultation with the psychiatric consultant; and provision of brief interventions using evidence-based techniques such as behavioral activation, motivational interviewing, and other focused treatment strategies. |
| 99493 | Subsequent psychiatric collaborative care management, first 60 minutes in a subsequent month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional, with the following required elements: tracking patient follow-up and progress using the registry, with appropriate documentation; participation in weekly caseload consultation with the psychiatric consultant; ongoing collaboration with and coordination of the patient’s mental health care with the treating physician or other qualified health care professional and any other treating mental health providers; additional review of progress and recommendations for changes in treatment, as indicated, including medications, based on recommendations provided by the psychiatric consultant; provision of brief interventions using evidence-based techniques such as behavioral activation, motivational interviewing, and other focused treatment strategies; monitoring of patient outcomes using validated rating scales; and relapse prevention planning with patients as they achieve remission of symptoms and/or other treatment goals and are prepared for discharge from active treatment. |
| G0101 | Cervical or vaginal cancer screening; pelvic and clinical breast examination |
| G0402 | Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment |
| G0438 | Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit |
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit |
| G0444 | Annual depression screening, 15 minutes |
| SNOMED: | |
| Code | Description |
| 10197000 | Psychiatric interview and evaluation (procedure) |
| 108220007 | Evaluation AND/OR management – new patient (procedure) |
| 108221006 | Evaluation AND/OR management – established patient (procedure) |
| 108224003 | Preventive patient evaluation (procedure) |
| 108311000 | Psychiatric procedure, interview AND/OR consultation (procedure) |
| 13607009 | Manual examination of breast (procedure) |
| 14736009 | History and physical examination with evaluation and management of patient (procedure) |
| 165171009 | Initial psychiatric evaluation (procedure) |
| 171207006 | Depression screening (procedure) |
| 18512000 | Individual psychotherapy (regime/therapy) |
| 185349003 | Encounter for check up (procedure) |
| 185463005 | Visit out of hours (procedure) |
| 185465003 | Weekend visit (procedure) |
| 252603000 | Tinnitus assessment (procedure) |
| 270427003 | Patient-initiated encounter (procedure) |
| 270430005 | Provider-initiated encounter (procedure) |
| 302440009 | Psychiatric pharmacologic management (procedure) |
| 308335008 | Patient encounter procedure (procedure) |
| 33849009 | Diagnostic physical therapy procedure (regime/therapy) |
| 35025007 | Manual pelvic examination (procedure) |
| 370803007 | Evaluation of psychosocial impact on plan of care (procedure) |
| 390906007 | Follow-up encounter (procedure) |
| 406547006 | Urgent follow-up (procedure) |
| 410155007 | Occupational therapy assessment (procedure) |
| 410157004 | Occupational therapy management (procedure) |
| 46662001 | Examination of breast (procedure) |
| 53555003 | Basic comprehensive audiometry testing (procedure) |
| 78318003 | History and physical examination, annual for health maintenance (procedure) |
| 83607001 | Gynecologic examination (procedure) |
| 8411005 | Interactive individual medical psychotherapy (regime/therapy) |
| 86013001 | Periodic reevaluation and management of healthy individual (procedure) |
| 90526000 | Initial evaluation and management of healthy individual (procedure) |
Denominator Exclusions & Exceptions:
Denominator exclusions include patients who have been diagnosed with depression or bipolar disorder prior to the start of the qualifying encounter for the denominator.
Denominator exceptions include Patient Reasons (the patient refuses to participate) or Medical Reasons (e.g., cognitive, functional, or motivational limitations that may impact accuracy of results; patient is in an urgent or emergent situation where time is of the essence and to delay treatment would jeopardize the patient’s health status) for not screening the patient.
If one of the following is documented in the chart, the patient will not be included in the denominator:
This is captured by adding a diagnosis with a valid ICD10 or SNOMED code using the Diagnosis widget in a note.
| ICD-10: | |
| Code | Description |
| F01.51 | Vascular dementia with behavioral disturbance |
| F32.0 | Major depressive disorder, single episode, mild |
| F32.1 | Major depressive disorder, single episode, moderate |
| F32.2 | Major depressive disorder, single episode, severe without psychotic features |
| F32.3 | Major depressive disorder, single episode, severe with psychotic features |
| F32.4 | Major depressive disorder, single episode, in partial remission |
| F32.5 | Major depressive disorder, single episode, in full remission |
| F32.89 | Other specified depressive episodes |
| F32.9 | Major depressive disorder, single episode, unspecified |
| F33.0 | Major depressive disorder, recurrent, mild |
| F33.1 | Major depressive disorder, recurrent, moderate |
| F33.2 | Major depressive disorder, recurrent severe without psychotic features |
| F33.3 | Major depressive disorder, recurrent, severe with psychotic symptoms |
| F33.40 | Major depressive disorder, recurrent, in remission, unspecified |
| F33.41 | Major depressive disorder, recurrent, in partial remission |
| F33.42 | Major depressive disorder, recurrent, in full remission |
| F33.8 | Other recurrent depressive disorders |
| F33.9 | Major depressive disorder, recurrent, unspecified |
| F34.1 | Dysthymic disorder |
| F34.81 | Disruptive mood dysregulation disorder |
| F34.89 | Other specified persistent mood disorders |
| F43.21 | Adjustment disorder with depressed mood |
| F43.23 | Adjustment disorder with mixed anxiety and depressed mood |
| F53.0 | Postpartum depression |
| F53.1 | Puerperal psychosis |
| SNOMED: | |
| Code | Description |
| 10811121000119102 | Major depressive disorder in mother complicating childbirth (disorder) |
| 133121000119109 | Severe seasonal affective disorder (disorder) |
| 14183003 | Chronic major depressive disorder, single episode (disorder) |
| 15193003 | Severe recurrent major depression with psychotic features, mood-incongruent (disorder) |
| 15639000 | Moderate major depression, single episode (disorder) |
| 18818009 | Moderate recurrent major depression (disorder) |
| 191604000 | Single major depressive episode, severe, with psychosis (disorder) |
| 191610000 | Recurrent major depressive episodes, mild (disorder) |
| 191611001 | Recurrent major depressive episodes, moderate (disorder) |
| 191613003 | Recurrent major depressive episodes, severe, with psychosis (disorder) |
| 191616006 | Recurrent depression (disorder) |
| 191659001 | Atypical depressive disorder (disorder) |
| 192080009 | Chronic depression (disorder) |
| 19527009 | Single episode of major depression in full remission (disorder) |
| 19694002 | Late onset dysthymia (disorder) |
| 20250007 | Severe major depression, single episode, with psychotic features, mood-incongruent (disorder) |
| 231504006 | Mixed anxiety and depressive disorder (disorder) |
| 231542000 | Depressive conduct disorder (disorder) |
| 2506003 | Early onset dysthymia (disorder) |
| 25922000 | Major depressive disorder, single episode with postpartum onset (disorder) |
| 2618002 | Chronic recurrent major depressive disorder (disorder) |
| 268621008 | Recurrent major depressive episodes (disorder) |
| 28475009 | Severe recurrent major depression with psychotic features (disorder) |
| 3109008 | Secondary dysthymia early onset (disorder) |
| 319768000 | Recurrent major depressive disorder with melancholic features (disorder) |
| 320751009 | Major depression, melancholic type (disorder) |
| 33078009 | Severe recurrent major depression with psychotic features, mood-congruent (disorder) |
| 35489007 | Depressive disorder (disorder) |
| 36170009 | Secondary dysthymia late onset (disorder) |
| 36474008 | Severe recurrent major depression without psychotic features (disorder) |
| 36923009 | Major depression, single episode (disorder) |
| 370143000 | Major depressive disorder (disorder) |
| 38451003 | Primary dysthymia early onset (disorder) |
| 38694004 | Recurrent major depressive disorder with atypical features (disorder) |
| 39809009 | Recurrent major depressive disorder with catatonic features (disorder) |
| 40379007 | Mild recurrent major depression (disorder) |
| 40568001 | Recurrent brief depressive disorder (disorder) |
| 42925002 | Major depressive disorder, single episode with atypical features (disorder) |
| 430852001 | Severe major depression, single episode, with psychotic features (disorder) |
| 442057004 | Chronic depressive personality disorder (disorder) |
| 48589009 | Minor depressive disorder (disorder) |
| 63778009 | Major depressive disorder, single episode with melancholic features (disorder) |
| 66344007 | Recurrent major depression (disorder) |
| 67711008 | Primary dysthymia late onset (disorder) |
| 69392006 | Major depressive disorder, single episode with catatonic features (disorder) |
| 71336009 | Recurrent major depressive disorder with postpartum onset (disorder) |
| 73867007 | Severe major depression with psychotic features (disorder) |
| 75084000 | Severe major depression without psychotic features (disorder) |
| 75837004 | Mood disorder with depressive features due to general medical condition (disorder) |
| 76441001 | Severe major depression, single episode, without psychotic features (disorder) |
| 77486005 | Mood disorder with major depressive-like episode due to general medical condition (disorder) |
| 77911002 | Severe major depression, single episode, with psychotic features, mood-congruent (disorder) |
| 78667006 | Dysthymia (disorder) |
| 79298009 | Mild major depression, single episode (disorder) |
| 81319007 | Severe bipolar II disorder, most recent episode major depressive without psychotic features (disorder) |
| 83176005 | Primary dysthymia (disorder) |
| 832007 | Moderate major depression (disorder) |
| 84760002 | Schizoaffective disorder, depressive type (disorder) |
| 85080004 | Secondary dysthymia (disorder) |
| 87512008 | Mild major depression (disorder) |
This is captured by adding a diagnosis with a valid ICD10 or SNOMED code using the Diagnosis widget in a note.
| ICD-10: | |
| Code | Description |
| F31.0 | Bipolar disorder, current episode hypomanic |
| F31.10 | Bipolar disorder, current episode manic without psychotic features, unspecified |
| F31.11 | Bipolar disorder, current episode manic without psychotic features, mild |
| F31.12 | Bipolar disorder, current episode manic without psychotic features, moderate |
| F31.13 | Bipolar disorder, current episode manic without psychotic features, severe |
| F31.2 | Bipolar disorder, current episode manic severe with psychotic features |
| F31.30 | Bipolar disorder, current episode depressed, mild or moderate severity, unspecified |
| F31.31 | Bipolar disorder, current episode depressed, mild |
| F31.32 | Bipolar disorder, current episode depressed, moderate |
| F31.4 | Bipolar disorder, current episode depressed, severe, without psychotic features |
| F31.5 | Bipolar disorder, current episode depressed, severe, with psychotic features |
| F31.60 | Bipolar disorder, current episode mixed, unspecified |
| F31.61 | Bipolar disorder, current episode mixed, mild |
| F31.62 | Bipolar disorder, current episode mixed, moderate |
| F31.63 | Bipolar disorder, current episode mixed, severe, without psychotic features |
| F31.64 | Bipolar disorder, current episode mixed, severe, with psychotic features |
| F31.70 | Bipolar disorder, currently in remission, most recent episode unspecified |
| F31.71 | Bipolar disorder, in partial remission, most recent episode hypomanic |
| F31.72 | Bipolar disorder, in full remission, most recent episode hypomanic |
| F31.73 | Bipolar disorder, in partial remission, most recent episode manic |
| F31.74 | Bipolar disorder, in full remission, most recent episode manic |
| F31.75 | Bipolar disorder, in partial remission, most recent episode depressed |
| F31.76 | Bipolar disorder, in full remission, most recent episode depressed |
| F31.77 | Bipolar disorder, in partial remission, most recent episode mixed |
| F31.78 | Bipolar disorder, in full remission, most recent episode mixed |
| F31.81 | Bipolar II disorder |
| F31.89 | Other bipolar disorder |
| F31.9 | Bipolar disorder, unspecified |
| SNOMED: | |
| Code | Description |
| 13581000 | Severe bipolar I disorder, single manic episode with psychotic features, mood-congruent (disorder) |
| 13746004 | Bipolar disorder (disorder) |
| 14495005 | Severe bipolar I disorder, single manic episode without psychotic features (disorder) |
| 1499003 | Bipolar I disorder, single manic episode with postpartum onset (disorder) |
| 162004 | Severe manic bipolar I disorder without psychotic features (disorder) |
| 16295005 | Bipolar II disorder, most recent episode major depressive (disorder) |
| 16506000 | Mixed bipolar I disorder (disorder) |
| 17782008 | Bipolar I disorder, most recent episode manic with catatonic features (disorder) |
| 191618007 | Bipolar affective disorder, current episode manic (disorder) |
| 191620005 | Bipolar affective disorder, currently manic, mild (disorder) |
| 191621009 | Bipolar affective disorder, currently manic, moderate (disorder) |
| 191623007 | Bipolar affective disorder, currently manic, severe, with psychosis (disorder) |
| 191625000 | Bipolar affective disorder, currently manic, in full remission (disorder) |
| 191627008 | Bipolar affective disorder, current episode depression (disorder) |
| 191629006 | Bipolar affective disorder, currently depressed, mild (disorder) |
| 191630001 | Bipolar affective disorder, currently depressed, moderate (disorder) |
| 191634005 | Bipolar affective disorder, currently depressed, in full remission (disorder) |
| 191636007 | Mixed bipolar affective disorder (disorder) |
| 191638008 | Mixed bipolar affective disorder, mild (disorder) |
| 191639000 | Mixed bipolar affective disorder, moderate (disorder) |
| 191641004 | Mixed bipolar affective disorder, severe, with psychosis (disorder) |
| 191643001 | Mixed bipolar affective disorder, in full remission (disorder) |
| 192362008 | Bipolar affective disorder, current episode mixed (disorder) |
| 19300006 | Severe bipolar II disorder, most recent episode major depressive with psychotic features, mood-congruent (disorder) |
| 20960007 | Severe bipolar II disorder, most recent episode major depressive with psychotic features, mood-incongruent (disorder) |
| 21900002 | Bipolar I disorder, most recent episode depressed with catatonic features (disorder) |
| 22121000 | Depressed bipolar I disorder in full remission (disorder) |
| 22407005 | Bipolar II disorder, most recent episode major depressive with catatonic features (disorder) |
| 231444002 | Organic bipolar disorder (disorder) |
| 23741000119105 | Severe manic bipolar I disorder (disorder) |
| 261000119107 | Severe depressed bipolar I disorder (disorder) |
| 26203008 | Severe depressed bipolar I disorder with psychotic features, mood-incongruent (disorder) |
| 26530004 | Severe bipolar disorder with psychotic features, mood-incongruent (disorder) |
| 271000119101 | Severe mixed bipolar I disorder (disorder) |
| 28663008 | Severe manic bipolar I disorder with psychotic features (disorder) |
| 28884001 | Moderate bipolar I disorder, single manic episode (disorder) |
| 29929003 | Bipolar I disorder, most recent episode depressed with atypical features (disorder) |
| 30520009 | Severe bipolar II disorder, most recent episode major depressive with psychotic features (disorder) |
| 30687003 | Bipolar II disorder, most recent episode major depressive with postpartum onset (disorder) |
| 30935000 | Manic bipolar I disorder in full remission (disorder) |
| 31446002 | Bipolar I disorder, most recent episode hypomanic (disorder) |
| 33380008 | Severe manic bipolar I disorder with psychotic features, mood-incongruent (disorder) |
| 34315001 | Bipolar II disorder, most recent episode major depressive with melancholic features (disorder) |
| 3530005 | Bipolar I disorder, single manic episode, in full remission (disorder) |
| 35481005 | Mixed bipolar I disorder in remission (disorder) |
| 35846004 | Moderate bipolar II disorder, most recent episode major depressive (disorder) |
| 36583000 | Mixed bipolar I disorder in partial remission (disorder) |
| 371596008 | Bipolar I disorder (disorder) |
| 371599001 | Severe bipolar I disorder (disorder) |
| 371600003 | Severe bipolar disorder (disorder) |
| 371604007 | Severe bipolar II disorder (disorder) |
| 38368003 | Schizoaffective disorder, bipolar type (disorder) |
| 40926005 | Moderate mixed bipolar I disorder (disorder) |
| 41552001 | Mild bipolar I disorder, single manic episode (disorder) |
| 41832009 | Severe bipolar I disorder, single manic episode with psychotic features (disorder) |
| 41836007 | Bipolar disorder in full remission (disorder) |
| 43568002 | Bipolar II disorder, most recent episode major depressive with atypical features (disorder) |
| 43769008 | Mild mixed bipolar I disorder (disorder) |
| 4441000 | Severe bipolar disorder with psychotic features (disorder) |
| 45479006 | Manic bipolar I disorder in remission (disorder) |
| 46229002 | Severe mixed bipolar I disorder without psychotic features (disorder) |
| 48937005 | Bipolar II disorder, most recent episode hypomanic (disorder) |
| 49468007 | Depressed bipolar I disorder (disorder) |
| 49512000 | Depressed bipolar I disorder in partial remission (disorder) |
| 51637008 | Chronic bipolar I disorder, most recent episode depressed (disorder) |
| 53049002 | Severe bipolar disorder without psychotic features (disorder) |
| 53607008 | Depressed bipolar I disorder in remission (disorder) |
| 54761006 | Severe depressed bipolar I disorder with psychotic features, mood-congruent (disorder) |
| 55516002 | Bipolar I disorder, most recent episode manic with postpartum onset (disorder) |
| 5703000 | Bipolar disorder in partial remission (disorder) |
| 59617007 | Severe depressed bipolar I disorder with psychotic features (disorder) |
| 61403008 | Severe depressed bipolar I disorder without psychotic features (disorder) |
| 63249007 | Manic bipolar I disorder in partial remission (disorder) |
| 64731001 | Severe mixed bipolar I disorder with psychotic features, mood-congruent (disorder) |
| 65042007 | Bipolar I disorder, most recent episode mixed with postpartum onset (disorder) |
| 66631006 | Moderate depressed bipolar I disorder (disorder) |
| 68569003 | Manic bipolar I disorder (disorder) |
| 70546001 | Severe bipolar disorder with psychotic features, mood-congruent (disorder) |
| 71294008 | Mild bipolar II disorder, most recent episode major depressive (disorder) |
| 71984005 | Mild manic bipolar I disorder (disorder) |
| 73471000 | Bipolar I disorder, most recent episode mixed with catatonic features (disorder) |
| 74686005 | Mild depressed bipolar I disorder (disorder) |
| 75360000 | Bipolar I disorder, single manic episode, in remission (disorder) |
| 75752004 | Bipolar I disorder, most recent episode depressed with melancholic features (disorder) |
| 78269000 | Bipolar I disorder, single manic episode, in partial remission (disorder) |
| 78640000 | Severe manic bipolar I disorder with psychotic features, mood-congruent (disorder) |
| 79584002 | Moderate bipolar disorder (disorder) |
| 81319007 | Severe bipolar II disorder, most recent episode major depressive without psychotic features (disorder) |
| 82998009 | Moderate manic bipolar I disorder (disorder) |
| 83225003 | Bipolar II disorder (disorder) |
| 85248005 | Bipolar disorder in remission (disorder) |
| 86058007 | Severe bipolar I disorder, single manic episode with psychotic features, mood-incongruent (disorder) |
| 87203005 | Bipolar I disorder, most recent episode depressed with postpartum onset (disorder) |
| 87950005 | Bipolar I disorder, single manic episode with catatonic features (disorder) |
| 9340000 | Bipolar I disorder, single manic episode (disorder) |
This is captured by attaching a valid SNOMED code to a procedure using the Procedure widget in a note.
| SNOMED: | |
| Code | Description |
| 105480006 | Refusal of treatment by patient (situation) |
| 183944003 | Procedure refused (situation) |
| 183945002 | Procedure refused for religious reason (situation) |
| 413310006 | Patient non-compliant – refused access to services (situation) |
| 413311005 | Patient non-compliant – refused intervention / support (situation) |
| 413312003 | Patient non-compliant – refused service (situation) |
This is captured by attaching a valid SNOMED code to a procedure using the Procedure widget in a note.
| SNOMED: | |
| Code | Description |
| 183932001 | Procedure contraindicated (situation) |
| 183964008 | Treatment not indicated (situation) |
| 183966005 | Drug treatment not indicated (situation) |
| 266721009 | Absent response to treatment (situation) |
| 269191009 | Late effect of medical and surgical care complication (disorder) |
| 31438003 | Drug resistance (disorder) |
| 35688006 | Complication of medical care (disorder) |
| 397745006 | Medical contraindication (finding) |
| 407563006 | Treatment not tolerated (situation) |
| 410534003 | Not indicated (qualifier value) |
| 410536001 | Contraindicated (qualifier value) |
| 416098002 | Allergy to drug (finding) |
| 428119001 | Procedure not indicated (situation) |
| 59037007 | Intolerance to drug (finding) |
| 62014003 | Adverse reaction caused by drug (disorder) |
| 79899007 | Drug interaction (finding) |
Required Data Elements for the Numerator:
This can be captured for patients ages 12 – 17 at the start of the measurement period, by completing the PHQ9-Modified for Teenagers panel via the Screening widget; and can be captured for patients 17 and older at the start of the measurement period, by completing the Quick Depression Assessment Panel (PHQ9) via the Screening widget.
PHQ9-Modified for Teenagers:
Quick Depression Assessment Panel (PHQ9):
If the screening is positive (a Total Score greater than 10) for depression, at least ONE of the following must also be documented during the eligible encounter:
This is captured by adding a procedure with a valid SNOMED code using the Procedure widget in a note.
Referral for Adolescent Depression
| CPT: | |
| Code | Description |
| 183524004 | Referral to psychiatry service (procedure) |
| 183583007 | Refer to mental health worker (procedure) |
| 183851006 | Referral to clinic (procedure) |
| 183866009 | Referral to emergency clinic (procedure) |
| 306136006 | Referral to liaison psychiatry service (procedure) |
| 306137002 | Referral to mental handicap psychiatry service (procedure) |
| 306226009 | Referral to mental health counseling service (procedure) |
| 306227000 | Referral for mental health counseling (procedure) |
| 306252003 | Referral to mental health counselor (procedure) |
| 306291008 | Referral to child and adolescent psychiatrist (procedure) |
| 306294000 | Referral to psychiatrist for mental handicap (procedure) |
| 308459004 | Referral to psychologist (procedure) |
| 308477009 | Referral to psychiatrist (procedure) |
| 309627007 | Child referral – clinical psychologist (procedure) |
| 390866009 | Referral to mental health team (procedure) |
| 703978000 | Referral to primary care service (procedure) |
| 710914003 | Referral to family therapy (procedure) |
| 711281004 | Referral to support group (procedure) |
Referral for Adult Depression
| CPT: | |
| Code | Description |
| 183524004 | Referral to psychiatry service (procedure) |
| 183528001 | Referral to psychiatrist for the elderly mentally ill (procedure) |
| 183583007 | Refer to mental health worker (procedure) |
| 183866009 | Referral to emergency clinic (procedure) |
| 305922005 | Referral by mental health counselor (procedure) |
| 306136006 | Referral to liaison psychiatry service (procedure) |
| 306137002 | Referral to mental handicap psychiatry service (procedure) |
| 306138007 | Referral to psychogeriatric service (procedure) |
| 306204008 | Referral to psychogeriatric day hospital (procedure) |
| 306226009 | Referral to mental health counseling service (procedure) |
| 306227000 | Referral for mental health counseling (procedure) |
| 306252003 | Referral to mental health counselor (procedure) |
| 306294000 | Referral to psychiatrist for mental handicap (procedure) |
| 308459004 | Referral to psychologist (procedure) |
| 308477009 | Referral to psychiatrist (procedure) |
| 390866009 | Referral to mental health team (procedure) |
| 703978000 | Referral to primary care service (procedure) |
| 710914003 | Referral to family therapy (procedure) |
| 711281004 | Referral to support group (procedure) |
This is captured by prescribing or renewing a medication with a valid RXNORM code.
Adolescent Depression Medications
| RXNORM: | |
| Code | Description |
| 1190110 | fluoxetine 60 MG Oral Tablet |
| 200371 | citalopram 20 MG Oral Tablet |
| 248642 | fluoxetine 20 MG Oral Tablet |
| 283406 | mirtazapine 15 MG Disintegrating Oral Tablet |
| 283407 | mirtazapine 30 MG Disintegrating Oral Tablet |
| 283485 | mirtazapine 45 MG Disintegrating Oral Tablet |
| 283672 | citalopram 10 MG Oral Tablet |
| 309313 | citalopram 2 MG/ML Oral Solution |
| 309314 | citalopram 40 MG Oral Tablet |
| 310384 | fluoxetine 10 MG Oral Capsule |
| 310385 | fluoxetine 20 MG Oral Capsule |
| 310386 | fluoxetine 4 MG/ML Oral Solution |
| 311725 | mirtazapine 15 MG Oral Tablet |
| 311726 | mirtazapine 45 MG Oral Tablet |
| 312938 | sertraline 100 MG Oral Tablet |
| 312940 | sertraline 25 MG Oral Tablet |
| 312941 | sertraline 50 MG Oral Tablet |
| 313580 | venlafaxine 100 MG Oral Tablet |
| 313581 | 24 HR venlafaxine 150 MG Extended Release Oral Capsule |
| 313582 | venlafaxine 25 MG Oral Tablet |
| 313583 | 24 HR venlafaxine 37.5 MG Extended Release Oral Capsule |
| 313584 | venlafaxine 37.5 MG Oral Tablet |
| 313585 | 24 HR venlafaxine 75 MG Extended Release Oral Capsule |
| 313586 | venlafaxine 75 MG Oral Tablet |
| 313989 | fluoxetine 40 MG Oral Capsule |
| 313990 | fluoxetine 10 MG Oral Tablet |
| 313995 | fluoxetine 90 MG Delayed Release Oral Capsule |
| 314111 | mirtazapine 30 MG Oral Tablet |
| 314277 | venlafaxine 50 MG Oral Tablet |
| 349332 | escitalopram 10 MG Oral Tablet |
| 351249 | escitalopram 5 MG Oral Tablet |
| 351250 | escitalopram 20 MG Oral Tablet |
| 351285 | escitalopram 1 MG/ML Oral Solution |
| 476809 | mirtazapine 7.5 MG Oral Tablet |
| 596926 | duloxetine 20 MG Delayed Release Oral Capsule |
| 596930 | duloxetine 30 MG Delayed Release Oral Capsule |
| 596934 | duloxetine 60 MG Delayed Release Oral Capsule |
| 616402 | duloxetine 40 MG Delayed Release Oral Capsule |
| 808744 | 24 HR venlafaxine 150 MG Extended Release Oral Tablet |
| 808748 | 24 HR venlafaxine 225 MG Extended Release Oral Tablet |
| 808751 | 24 HR venlafaxine 37.5 MG Extended Release Oral Tablet |
| 808753 | 24 HR venlafaxine 75 MG Extended Release Oral Tablet |
| 861064 | sertraline 20 MG/ML Oral Solution |
Adult Depression Medications
| RXNORM: | |
| Code | Description |
| 1000048 | doxepin hydrochloride 10 MG Oral Capsule |
| 1000054 | doxepin hydrochloride 10 MG/ML Oral Solution |
| 1000058 | doxepin hydrochloride 100 MG Oral Capsule |
| 1000064 | doxepin hydrochloride 150 MG Oral Capsule |
| 1000070 | doxepin hydrochloride 25 MG Oral Capsule |
| 1000076 | doxepin hydrochloride 50 MG Oral Capsule |
| 1000097 | doxepin hydrochloride 75 MG Oral Capsule |
| 103968 | lamotrigine 100 MG Disintegrating Oral Tablet |
| 1086772 | vilazodone hydrochloride 10 MG Oral Tablet |
| 1086778 | vilazodone hydrochloride 20 MG Oral Tablet |
| 1086784 | vilazodone hydrochloride 40 MG Oral Tablet |
| 1086789 | {7 (vilazodone hydrochloride 10 MG Oral Tablet) / 7 (vilazodone hydrochloride 20 MG Oral Tablet) / 16 (vilazodone hydrochloride 40 MG Oral Tablet) } Pack |
| 1098608 | 24 HR lamotrigine 300 MG Extended Release Oral Tablet |
| 1098649 | nefazodone hydrochloride 100 MG Oral Tablet |
| 1098666 | nefazodone hydrochloride 150 MG Oral Tablet |
| 1098670 | nefazodone hydrochloride 200 MG Oral Tablet |
| 1098674 | nefazodone hydrochloride 250 MG Oral Tablet |
| 1098678 | nefazodone hydrochloride 50 MG Oral Tablet |
| 1099288 | desipramine hydrochloride 10 MG Oral Tablet |
| 1099292 | desipramine hydrochloride 100 MG Oral Tablet |
| 1099296 | desipramine hydrochloride 150 MG Oral Tablet |
| 1099300 | desipramine hydrochloride 25 MG Oral Tablet |
| 1099304 | desipramine hydrochloride 50 MG Oral Tablet |
| 1099316 | desipramine hydrochloride 75 MG Oral Tablet |
| 1146690 | 24 HR lamotrigine 250 MG Extended Release Oral Tablet |
| 1190110 | fluoxetine 60 MG Oral Tablet |
| 1232585 | 24 HR bupropion hydrochloride 450 MG Extended Release Oral Tablet |
| 1298857 | maprotiline hydrochloride 25 MG Oral Tablet |
| 1298861 | maprotiline hydrochloride 50 MG Oral Tablet |
| 1298870 | maprotiline hydrochloride 75 MG Oral Tablet |
| 1738483 | paroxetine hydrochloride 10 MG Oral Tablet |
| 1738495 | paroxetine hydrochloride 20 MG Oral Tablet |
| 1738503 | paroxetine hydrochloride 30 MG Oral Tablet |
| 1738511 | paroxetine hydrochloride 40 MG Oral Tablet |
| 1738515 | paroxetine mesylate 10 MG Oral Tablet |
| 1738519 | paroxetine mesylate 20 MG Oral Tablet |
| 1738523 | paroxetine mesylate 30 MG Oral Tablet |
| 1738527 | paroxetine mesylate 40 MG Oral Tablet |
| 1738803 | 24 HR paroxetine hydrochloride 12.5 MG Extended Release Oral Tablet |
| 1738805 | 24 HR paroxetine hydrochloride 25 MG Extended Release Oral Tablet |
| 1738807 | 24 HR paroxetine hydrochloride 37.5 MG Extended Release Oral Tablet |
| 197363 | amoxapine 100 MG Oral Tablet |
| 197364 | amoxapine 150 MG Oral Tablet |
| 197365 | amoxapine 25 MG Oral Tablet |
| 197366 | amoxapine 50 MG Oral Tablet |
| 198045 | nortriptyline 10 MG Oral Capsule |
| 198046 | nortriptyline 50 MG Oral Capsule |
| 198047 | nortriptyline 75 MG Oral Capsule |
| 198427 | lamotrigine 100 MG Oral Tablet |
| 198428 | lamotrigine 150 MG Oral Tablet |
| 198429 | lamotrigine 200 MG Oral Tablet |
| 198430 | lamotrigine 25 MG Disintegrating Oral Tablet |
| 200371 | citalopram 20 MG Oral Tablet |
| 248642 | fluoxetine 20 MG Oral Tablet |
| 252478 | lamotrigine 50 MG Disintegrating Oral Tablet |
| 252479 | lamotrigine 200 MG Disintegrating Oral Tablet |
| 282401 | lamotrigine 25 MG Oral Tablet |
| 283406 | mirtazapine 15 MG Disintegrating Oral Tablet |
| 283407 | mirtazapine 30 MG Disintegrating Oral Tablet |
| 283485 | mirtazapine 45 MG Disintegrating Oral Tablet |
| 283672 | citalopram 10 MG Oral Tablet |
| 309313 | citalopram 2 MG/ML Oral Solution |
| 309314 | citalopram 40 MG Oral Tablet |
| 310384 | fluoxetine 10 MG Oral Capsule |
| 310385 | fluoxetine 20 MG Oral Capsule |
| 310386 | fluoxetine 4 MG/ML Oral Solution |
| 311264 | lamotrigine 25 MG Chewable Tablet |
| 311265 | lamotrigine 5 MG Chewable Tablet |
| 311725 | mirtazapine 15 MG Oral Tablet |
| 311726 | mirtazapine 45 MG Oral Tablet |
| 312036 | nortriptyline 2 MG/ML Oral Solution |
| 312242 | paroxetine hydrochloride 2 MG/ML Oral Suspension |
| 312347 | phenelzine 15 MG Oral Tablet |
| 312938 | sertraline 100 MG Oral Tablet |
| 312940 | sertraline 25 MG Oral Tablet |
| 312941 | sertraline 50 MG Oral Tablet |
| 313447 | tranylcypromine 10 MG Oral Tablet |
| 313496 | trimipramine 100 MG Oral Capsule |
| 313498 | trimipramine 25 MG Oral Capsule |
| 313499 | trimipramine 50 MG Oral Capsule |
| 313580 | venlafaxine 100 MG Oral Tablet |
| 313581 | 24 HR venlafaxine 150 MG Extended Release Oral Capsule |
| 313582 | venlafaxine 25 MG Oral Tablet |
| 313583 | 24 HR venlafaxine 37.5 MG Extended Release Oral Capsule |
| 313584 | venlafaxine 37.5 MG Oral Tablet |
| 313585 | 24 HR venlafaxine 75 MG Extended Release Oral Capsule |
| 313586 | venlafaxine 75 MG Oral Tablet |
| 313989 | fluoxetine 40 MG Oral Capsule |
| 313990 | fluoxetine 10 MG Oral Tablet |
| 313995 | fluoxetine 90 MG Delayed Release Oral Capsule |
| 314111 | mirtazapine 30 MG Oral Tablet |
| 314277 | venlafaxine 50 MG Oral Tablet |
| 317136 | nortriptyline 25 MG Oral Capsule |
| 349010 | lamotrigine 2 MG Chewable Tablet |
| 349332 | escitalopram 10 MG Oral Tablet |
| 351249 | escitalopram 5 MG Oral Tablet |
| 351250 | escitalopram 20 MG Oral Tablet |
| 351285 | escitalopram 1 MG/ML Oral Solution |
| 410503 | 5-hydroxytryptophan 100 MG Oral Capsule |
| 476809 | mirtazapine 7.5 MG Oral Tablet |
| 485514 | 5-hydroxytryptophan 50 MG Oral Capsule |
| 596926 | duloxetine 20 MG Delayed Release Oral Capsule |
| 596930 | duloxetine 30 MG Delayed Release Oral Capsule |
| 596934 | duloxetine 60 MG Delayed Release Oral Capsule |
| 616402 | duloxetine 40 MG Delayed Release Oral Capsule |
| 751139 | {35 (lamotrigine 25 MG Oral Tablet) } Pack |
| 751563 | {7 (lamotrigine 100 MG Oral Tablet) / 42 (lamotrigine 25 MG Oral Tablet) } Pack |
| 753451 | {14 (lamotrigine 100 MG Oral Tablet) / 84 (lamotrigine 25 MG Oral Tablet) } Pack |
| 790264 | 24 HR desvenlafaxine 100 MG Extended Release Oral Tablet |
| 790288 | 24 HR desvenlafaxine 50 MG Extended Release Oral Tablet |
| 808744 | 24 HR venlafaxine 150 MG Extended Release Oral Tablet |
| 808748 | 24 HR venlafaxine 225 MG Extended Release Oral Tablet |
| 808751 | 24 HR venlafaxine 37.5 MG Extended Release Oral Tablet |
| 808753 | 24 HR venlafaxine 75 MG Extended Release Oral Tablet |
| 835564 | imipramine hydrochloride 25 MG Oral Tablet |
| 835568 | imipramine hydrochloride 50 MG Oral Tablet |
| 835572 | imipramine pamoate 75 MG Oral Capsule |
| 835577 | imipramine pamoate 150 MG Oral Capsule |
| 835589 | imipramine pamoate 125 MG Oral Capsule |
| 835591 | imipramine pamoate 100 MG Oral Capsule |
| 835593 | imipramine hydrochloride 10 MG Oral Tablet |
| 850087 | 24 HR lamotrigine 100 MG Extended Release Oral Tablet |
| 850091 | 24 HR lamotrigine 50 MG Extended Release Oral Tablet |
| 851748 | {21 (lamotrigine 25 MG Disintegrating Oral Tablet) / 7 (lamotrigine 50 MG Disintegrating Oral Tablet) } Pack |
| 851750 | {7 (lamotrigine 100 MG Disintegrating Oral Tablet) / 14 (lamotrigine 25 MG Disintegrating Oral Tablet) / 14 (lamotrigine 50 MG Disintegrating Oral Tablet) } Pack |
| 851752 | {14 (lamotrigine 100 MG Disintegrating Oral Tablet) / 42 (lamotrigine 50 MG Disintegrating Oral Tablet) } Pack |
| 856364 | trazodone hydrochloride 150 MG Oral Tablet |
| 856369 | trazodone hydrochloride 300 MG Oral Tablet |
| 856373 | trazodone hydrochloride 100 MG Oral Tablet |
| 856377 | trazodone hydrochloride 50 MG Oral Tablet |
| 856706 | amitriptyline hydrochloride 10 MG / perphenazine 2 MG Oral Tablet |
| 856720 | amitriptyline hydrochloride 10 MG / perphenazine 4 MG Oral Tablet |
| 856762 | amitriptyline hydrochloride 100 MG Oral Tablet |
| 856769 | amitriptyline hydrochloride 12.5 MG / chlordiazepoxide 5 MG Oral Tablet |
| 856773 | amitriptyline hydrochloride 150 MG Oral Tablet |
| 856783 | amitriptyline hydrochloride 10 MG Oral Tablet |
| 856792 | amitriptyline hydrochloride 25 MG / chlordiazepoxide 10 MG Oral Tablet |
| 856797 | amitriptyline hydrochloride 25 MG / perphenazine 2 MG Oral Tablet |
| 856825 | amitriptyline hydrochloride 25 MG / perphenazine 4 MG Oral Tablet |
| 856834 | amitriptyline hydrochloride 25 MG Oral Tablet |
| 856840 | amitriptyline hydrochloride 50 MG / perphenazine 4 MG Oral Tablet |
| 856845 | amitriptyline hydrochloride 50 MG Oral Tablet |
| 856853 | amitriptyline hydrochloride 75 MG Oral Tablet |
| 857297 | clomipramine hydrochloride 25 MG Oral Capsule |
| 857301 | clomipramine hydrochloride 50 MG Oral Capsule |
| 857305 | clomipramine hydrochloride 75 MG Oral Capsule |
| 859186 | selegiline hydrochloride 5 MG Oral Capsule |
| 859190 | selegiline hydrochloride 1.25 MG Disintegrating Oral Tablet |
| 859193 | selegiline hydrochloride 5 MG Oral Tablet |
| 861064 | sertraline 20 MG/ML Oral Solution |
| 865206 | 24 HR selegiline 0.25 MG/HR Transdermal System |
| 865210 | 24 HR selegiline 0.375 MG/HR Transdermal System |
| 865214 | 24 HR selegiline 0.5 MG/HR Transdermal System |
| 898697 | 24 HR trazodone hydrochloride 150 MG Extended Release Oral Tablet |
| 898704 | 24 HR trazodone hydrochloride 300 MG Extended Release Oral Tablet |
| 900156 | 24 HR lamotrigine 200 MG Extended Release Oral Tablet |
| 900164 | 24 HR lamotrigine 25 MG Extended Release Oral Tablet |
| 900865 | {14 (24 HR lamotrigine 100 MG Extended Release Oral Tablet) / 7 (24 HR lamotrigine 200 MG Extended Release Oral Tablet) / 14 (24 HR lamotrigine 50 MG Extended Release Oral Tablet) } Pack |
| 900890 | {7 (24 HR lamotrigine 100 MG Extended Release Oral Tablet) / 14 (24 HR lamotrigine 25 MG Extended Release Oral Tablet) / 14 (24 HR lamotrigine 50 MG Extended Release Oral Tablet) } Pack |
| 900983 | {21 (24 HR lamotrigine 25 MG Extended Release Oral Tablet) / 7 (24 HR lamotrigine 50 MG Extended Release Oral Tablet) } Pack |
| 903873 | 24 HR fluvoxamine maleate 100 MG Extended Release Oral Capsule |
| 903879 | 24 HR fluvoxamine maleate 150 MG Extended Release Oral Capsule |
| 903884 | fluvoxamine maleate 100 MG Oral Tablet |
| 903887 | fluvoxamine maleate 25 MG Oral Tablet |
| 903891 | fluvoxamine maleate 50 MG Oral Tablet |
| 905168 | protriptyline hydrochloride 10 MG Oral Tablet |
| 905172 | protriptyline hydrochloride 5 MG Oral Tablet |
| 966787 | doxepin 3 MG Oral Tablet |
| 966793 | doxepin 6 MG Oral Tablet |
| 993503 | 12 HR bupropion hydrochloride 100 MG Extended Release Oral Tablet |
| 993518 | 12 HR bupropion hydrochloride 150 MG Extended Release Oral Tablet |
| 993536 | 12 HR bupropion hydrochloride 200 MG Extended Release Oral Tablet |
| 993541 | 24 HR bupropion hydrochloride 150 MG Extended Release Oral Tablet |
| 993550 | 24 HR bupropion hydrobromide 174 MG Extended Release Oral Tablet |
| 993557 | 24 HR bupropion hydrochloride 300 MG Extended Release Oral Tablet |
| 993567 | 24 HR bupropion hydrobromide 348 MG Extended Release Oral Tablet |
| 993681 | 24 HR bupropion hydrobromide 522 MG Extended Release Oral Tablet |
| 993687 | bupropion hydrochloride 100 MG Oral Tablet |
| 993691 | bupropion hydrochloride 75 MG Oral Tablet |
Measure Guidance:
The intent of the measure is to screen for depression in patients who have never had a diagnosis of depression or bipolar disorder prior to the eligible encounter used to evaluate the numerator. Patients who have ever been diagnosed with depression or bipolar disorder will be excluded from the measure.
A depression screen is completed on the date of the encounter or up to 14 days prior to the date of the encounter using an age-appropriate standardized depression screening tool AND if positive, a follow-up plan must be documented on the date of the encounter, such as referral to a provider for additional evaluation, pharmacological interventions, or other interventions for the treatment of depression.
This measure does not require documentation of a specific score, just whether results of the normalized and validated depression screening tool used are considered positive or negative. Each standardized screening tool provides guidance on whether a particular score is considered positive for depression.
This eCQM is a patient-based measure. Depression screening is required once per measurement period, not at all encounters.
Screening Tools:
- An age-appropriate, standardized, and validated depression screening tool must be used for numerator compliance.
- The name of the age-appropriate standardized depression screening tool utilized must be documented in the medical record.
- The depression screening must be reviewed and addressed by the provider, filing the code, on the date of the encounter. Positive pre-screening results indicating a patient is at high risk for self-harm should receive more urgent intervention as determined by the provider practice.
- The screening should occur during a qualifying encounter or up to 14 days prior to the date of the qualifying encounter.
- The measure assesses the most recent depression screening completed either during the eligible encounter or within the 14 days prior to that encounter. Therefore, a clinician would not be able to complete another screening at the time of the encounter to count towards a follow-up, because that would serve as the most recent screening. In order to satisfy the follow-up requirement for a patient screening positively, the eligible clinician would need to provide one of the aforementioned follow-up actions, which does not include use of a standardized depression screening tool.
Follow-Up Plan:
The follow-up plan must be related to a positive depression screening, for example: “Patient referred for psychiatric evaluation due to positive depression screening.”
Examples of a follow-up plan include but are not limited to:
- Referral to a provider or program for further evaluation for depression, for example, referral to a psychiatrist, psychologist, social worker, mental health counselor, or other mental health service such as family or group therapy, support group, depression management program, or other service for treatment of depression.
- Other interventions designed to treat depression such as behavioral health evaluation, psychotherapy, pharmacological interventions, or additional treatment options.
Should a patient screen positive for depression, a clinician should:
- Only order pharmacological intervention when appropriate and after sufficient diagnostic evaluation. However, for the purposes of this measure, additional screening and assessment during the qualifying encounter will not qualify as a follow-up plan.
- Opt to complete a suicide risk assessment when appropriate and based on individual patient characteristics. However, for the purposes of this measure, a suicide risk assessment or additional screening using a standardized tool will not qualify as a follow-up plan.