Billin Guidelines for Depression Screening

Reimbursement Guidelines for Depression Screening - CPT G0444

Depression screening CPT G0444 can't be coded with CPT G0402 & G0438 but you may report with CPT G0439. NCCI edits stated as "Code G0444 is a column 2 code for G0402. You may not override the edit".

Details of the CPTs,

• G0444 - Annual depression screening, 15 minutes
• 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 (PPPS), initial visit

Nationally Covered Indications:

CMS will cover annual screening up to 15 minutes for Medicare beneficiaries when staff-assisted depression care supports are in place to assure accurate diagnosis, effective treatment, and follow-up. 

At a minimum level, staff assisted supports consist of clinical staff (e.g., physician assistant, nurse) in the primary care setting who can advise the physician of screening results and who can facilitate and coordinate referrals to mental health treatment. Services covered under this NCD must be provided by a primary care provider.

Nationally Non-Covered Indications:

Screening for depression is non-covered when performed more than one time in a 12-month period. Also self-help materials, telephone calls, and web-based counseling are not separately reimbursable by Medicare and are not part of this NCD.

Medicare coinsurance and Part B deductible are waived for this preventive service.

Covered ICD Codes:

 

The specified below ICD codes are covered for depression screening services and may not be limited and some private payers have specific guidelines,

• F06.0 Psychotic disorder with hallucinations due to known physiological condition
• F06.2 Psychotic disorder with delusions due to known physiological condition
• F06.30 Mood disorder due to known physiological condition, unspecified
• F06.31 Mood disorder due to known physiological condition with depressive features
• F06.32 Mood disorder due to known physiological condition with major depressive-like episode
• F06.33 Mood disorder due to known physiological condition with manic features
• F06.34 Mood disorder due to known physiological condition with mixed features
• F06.4 Anxiety disorder due to known physiological condition
• F06.8 Other specified mental disorders due to known physiological condition
• F07.0 Personality change due to known physiological condition
• F07.89 Other personality and behavioral disorders due to known physiological condition
• F07.9 Unspecified personality and behavioral disorder due to known physiological condition
• F09 Unspecified mental disorder due to known physiological condition
• 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
• F32.81 Premenstrual dysphoric disorder
• F32.89 Other specified depressive episodes
• F32.9 Major depressive disorder, single episode, unspecified
• F32.A Depression, 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
• F43.21 Adjustment disorder with depressed mood
• F43.22 Adjustment disorder with anxiety
• F43.23 Adjustment disorder with mixed anxiety and depressed mood
• F43.24 Adjustment disorder with disturbance of conduct
• F43.25 Adjustment disorder with mixed disturbance of emotions and conduct
• F43.29 Adjustment disorder with other symptoms
• F53.0 Postpartum depression
• F53.1 Puerperal psychosis
• F68.A Factitious disorder imposed on another
• R45.88 Nonsuicidal self-harm
• Z13.31 Encounter for screening for depression
• Z13.32 Encounter for screening for maternal depression
• Z13.39 Encounter for screening examination for other mental health and behavioral disorders
  

 

Place Of Service:

Effective for claims with dates of service on and after April 2, 2012, contractors shall pay for annual depression screening claims, G0444, only when services are provided at the following Places of Service (POS)

• 11 Physician’s office
• 19 Off Campus-Outpatient hospital
• 22 On Campus-Outpatient hospital
• 49 Independent clinic 
• 71 State or local public health clinic