Medicare Reimbursement for Depression Screening in Adults
Medicare Benefit |
Reimbursed screening for depression in adults once-a-year under Fee-for-Service Medicare available since October 14, 2011. No coinsurance; no deductible for patient |
Value to you and your patients |
|
Procedure Code |
G0444 (Depression Screen – 15 minutes) |
Eligibility |
|
Referral Options |
If Behavioral Health specialist referral options are not available in your practice, consider consulting local community mental health center, local chapters of the American Psychiatric Association, the American Psychological Association or National Association of Social Work |
Recommended evidence-based screening tool with no license fee |
|
Provisional Diagnoses* and Treatment Guidelines based on PHQ-9 score
PHQ-9 Score |
Severity: Provisional Diagnoses* |
Proposed Actions/Treatment Considerations |
0-4 |
None: Minimal |
None |
5 - 9 |
Mild: Minimal depressive symptoms |
|
10-14 |
Moderate: Minor Depression, or Dysthymia |
|
15-19 |
Moderately severe: Depression |
|
20 or greater |
Severe: Major depression |
|
Adapted with modification from: Kroenke K, Spitzer RL, The PHQ-9: A new depression and diagnostic severity measure Psychiatric Annals 2002; 32:509-521
*A screening tool should not be the sole basis for a diagnosis. A more thorough evaluation is recommended.
Assessment of Suicidal Risk/Severity
If patient responds positively to question 9 of the PHQ-9 indicating the potential for suicidal actions, here are a set of questions you can use to help determine the severity (lethality) of the condition; and need for immediate hospitalization, expedited referral to behavioral healthcare professional and/or immediate initiation of anti-depressant medication.
1. Have you ever attempted to harm yourself in the past
2. Have you thought about how you might actually hurt yourself?
3. There’s a big difference between having a thought and acting on a thought On a scale from 1-5, 1 being unlikely and 5 being most likely; How likely are you to act on these thoughts about hurting yourself or ending your life during the next month?”
4. Is there anything that would prevent or keep you from harming yourself?
Adapted from: Dube P, Kroenke K, Bair MJ, Theobald D, Williams LS. The p4 screener: evaluation of a brief measure for assessing potential suicide risk in 2 randomized effectiveness trials of primary care and oncology patients. Prim Care Companion J Clin Psychiatry. 2010;12(6):PCC. 10m00978
Additional resources: http://www.healthteamworks.org/guidelines/depression.html
The ACP depression guide: http://depression.acponline.org/ps/main
Attachment | Size |
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Medicare Reimbursement for Depression Screening in Adults (2-page).pdf | 234.88 KB |