Depression Screening: Cpt Code For Private Insurance Claims

Depression is a common mental health condition that affects mood and can be difficult to diagnose. To help improve outcomes, it is important to screen for depression early and often. Medicare Part B covers an annual depression screening that includes a questionnaire designed to indicate if an individual is at risk or has symptoms of depression. This screening is covered at 100% of the Medicare-approved amount when received from a participating provider, meaning the individual does not pay anything out of pocket. For private insurance, the Current Procedural Terminology (CPT) codes for depression screening are 96127 and 99420, which are typically reimbursed at around $15 by private insurers.

CPT codes for depression screening

Depression is a common mental health condition that affects mood and can lead to serious consequences if left untreated. Early and frequent screening can help increase awareness, reduce stigma, and improve outcomes for patients. For this reason, it is important to understand the correct Current Procedural Terminology (CPT) codes for depression screening, which are used to bill and receive reimbursement for the service.

CPT Codes for Medicare

Medicare Part B covers an annual depression screening for individuals aged 18 and above, which must take place in a primary care setting, such as a doctor's office. The CPT code for this screening is G0444, which is a 15-minute time-based code. This code is used in conjunction with the ICD-10 code Z13.89, "Encounter for screening for other disorder." It is important to note that Medicare will not cover this screening if it is billed more than once in a 12-month period or if it is performed during a "Welcome to Medicare" visit or initial Annual Wellness Visit.

CPT Codes for Private Insurance

For private insurance, the CPT code for depression screening may vary depending on the insurance company and their policies. Some private insurers typically reimburse for the Patient Health Questionnaire 9-item (PHQ-9) screening using the CPT code 99420, "Administration and interpretation of a health risk assessment instrument." This code is submitted in conjunction with the diagnosis code Z13.89. Additionally, some plans provided by Blue Cross Blue Shield and United Healthcare also cover depression screening as a preventive service.

Other CPT Codes for Depression Screening

Other CPT codes related to depression screening include:

• 96127: This code specifically identifies the screening of a patient within a behavioral assessment for depression.
• 99483: This code includes an assessment for depression within the cognitive care plan.
• 1040F, 2060F, and 3088F – 3093F: These CPT Category II codes identify evaluations of major depressive disorder.
• 1220F, 3351F – 3354F, 3725F: These CPT Category II codes identify a patient screened for depression within the treatment of other clinical conditions.
• 4060F – 4067F: These CPT Category II codes identify various services provided for depression.

It is important to verify the correct CPT codes with the insurance company and follow their guidelines to ensure timely reimbursement for depression screening services.

Medicare and private insurance coverage

Medicare Part B covers an annual depression screening. This means that you can receive a screening once every 12 months. You do not need to show signs or symptoms of depression to qualify for screening. However, the screening must take place in a primary care setting, like a doctor's office. This means Medicare will not cover your screening if it takes place in an emergency room, skilled nursing facility, or hospital.

The annual depression screening includes a questionnaire that you can complete yourself or with the help of your doctor. This questionnaire is designed to indicate if you are at risk or have symptoms of depression. If your results show that you may be at risk of depression, your provider will perform a thorough assessment and refer you for follow-up mental health care if appropriate.

Medicare Advantage Plans are required to cover depression screenings without applying deductibles, copayments, or coinsurance when you see an in-network provider and meet Medicare's eligibility requirements for the service.

The CPT code for an annual depression screening is G0444, and the ICD-10 code is Z13.89, "Encounter for screening for other disorder." Depression screening services are not bundled and could be provided on the same day as a problem-oriented visit. Claims for depression screening will be denied when reported with a "Welcome to Medicare" visit or initial Medicare Annual Wellness Visit. Another common reason for claims denials is when depression screening is billed more than once in a 12-month period.

Private insurance companies, such as Aetna, Blue Cross Blue Shield, and United Healthcare, also cover depression screening as a preventive service. For example, Aetna will reimburse for the PHQ-9 screening if a provider submits CPT 99420, "Administration and interpretation of a health risk assessment instrument (e.g., health hazard appraisal)," in conjunction with diagnosis code Z13.89.

Patient Health Questionnaire (PHQ)

The Patient Health Questionnaire (PHQ) is a 3-page, self-administered questionnaire that can be completed by the patient before seeing the doctor. It is a diagnostic instrument for common mental disorders, and the PHQ-9 is the depression module. The PHQ-9 scores each of the 9 DSM-IV criteria as "0" (not at all) to "3" (nearly every day). A score of 10 or greater usually indicates major depression.

The PHQ-9 was completed by 6,000 patients in 8 primary care clinics and 7 obstetrics-gynecology clinics. The internal reliability of the PHQ-9 was excellent, with a Cronbach's α of 0.89 in the PHQ Primary Care Study and 0.86 in the PHQ Obstetrics-Gynecology Study. Test-retest reliability of the PHQ-9 was also excellent, with a correlation of 0.84 between the PHQ-9 completed by the patient in the clinic and that administered telephonically by a mental health professional within 48 hours.

The PHQ-9 is a useful clinical and research tool as it is a reliable and valid measure of depression severity. It is also brief, making it more likely to be used in busy clinical practice. The PHQ-9 has the potential to be a dual-purpose instrument, establishing depressive disorder diagnoses and grading depressive symptom severity with the same 9 items.

Screening tools for adolescents and adults

Depression is a common mental health disorder, with an estimated prevalence of 3% in younger children and about 8% in adolescents. It is the leading cause of disability in those aged 15 and older. The US Preventive Services Task Force (USPSTF) recommends routine screening for depression in adolescents aged 12 to 18 years in primary care settings.

There are several screening tools available for depression in adolescents and adults. Here are some commonly used ones:

• Patient Health Questionnaire (PHQ-9): This is a self-administered tool with nine items. It is used to screen for depressive symptoms and can also be used to establish a clinical diagnosis of depression and monitor symptom severity over time. A score of 10 or higher indicates moderate to severe depression.
• Beck Depression Inventory (BDI): The BDI is a widely used self-rating scale for individuals aged 13 to 80. It consists of 21 items and takes about 10 minutes to complete. It is used to screen for depression and assess the severity of depressive symptoms. Scores range from 0 to 63, with higher scores indicating more severe depression.
• Center for Epidemiologic Studies Depression Scale (CES-D): The CES-D is a 20-item self-report scale used as a screener for depression in primary care settings. It can be used for children as young as six and through older adulthood. It takes about 20 minutes to administer and score.
• Geriatric Depression Scale (GDS): The GDS is specifically designed for screening and assessing depression in older adults. It consists of 30 "yes" or "no" questions, making it suitable for individuals with cognitive dysfunction. It takes about five to seven minutes to complete.
• Edinburgh Postnatal Depression Scale (EPDS): This scale is used to detect post-partum depression in mothers.
• Duke Anxiety Depression Scale (DUKE-AD): This is a seven-item patient survey used to identify patients with anxiety and depression symptoms.

These screening tools can help identify individuals who may be at risk for depression and facilitate early intervention, which is crucial for improving outcomes.

Coding for depression screening

Depression screening is a critical aspect of healthcare, helping to identify patients who may be at risk or exhibiting symptoms of depression. Coding for depression screening ensures that healthcare providers can receive reimbursement for their services and facilitates timely payment for claims.

CPT Codes for Depression Screening

CPT (Current Procedural Terminology) codes are standardised codes used to report medical, surgical, and diagnostic procedures and services. CPT codes relevant to depression screening include:

• CPT 96127: This code specifically identifies the screening of a patient for depression within a behavioural assessment.
• CPT 99483: This code includes an assessment for depression within a cognitive care plan.
• CPT 99420: This code, "Administration and interpretation of a health risk assessment instrument", can be used for reimbursement for the PHQ-9 screening tool when submitted in conjunction with diagnosis code Z13.89.

LOINC Codes for Depression Screening

LOINC (Logical Observation Identifiers Names and Codes) is a database and coding system used for identifying medical test results. LOINC codes relevant to depression screening include:

• LOINC 55757-9: This code is for the PHQ-2 prescreen, which consists of the first two questions of the PHQ-9 screening tool.
• LOINC 44249-1: This code is for the full PHQ-9 screening tool.
• LOINC 89211-7: This code is for the Beck Depression Inventory Fast Screen (BDI FS), a shorter version of the Beck Depression Inventory II.

HCPCS and ICD-10 Codes for Depression Screening

In addition to CPT and LOINC codes, other coding systems are also used for billing and reimbursement purposes. These include:

• HCPCS G0444: This code is for annual depression screening and is used specifically for Medicare reimbursement.
• ICD-10 Z13.89: This diagnosis code, "Encounter for screening for other disorder", is used in conjunction with the HCPCS code G0444 for Medicare reimbursement.

Considerations for Coding and Reimbursement

It is important to note that correct coding and documentation are essential for reimbursement. Some considerations for depression screening coding and reimbursement include:

• Frequency of Screening: Depression screening is typically covered annually. Claims for depression screening may be denied if billed more than once in a 12-month period.
• Setting: Medicare covers depression screening in a primary care setting, such as a doctor's office. Screening in emergency rooms, skilled nursing facilities, or hospitals may not be covered.
• Patient Population: Depression screening codes may vary depending on the patient's age and other factors. For example, certain screening tools and codes are specific to adolescents, adults, pregnant or postpartum women, and geriatric patients.
• Follow-up Strategy: Proper documentation of a follow-up plan is essential for receiving credit for depression screening under certain quality reporting programs, such as PQRS (Physician Quality Reporting System).

Frequently asked questions