G9393 PHQ-9 Remission — HCPCS Reimbursement | OpenPayer

Summary & Overview

HCPCS G9393: PHQ-9 Remission at 12 Months

HCPCS Level II code G9393 documents a clinically meaningful outcome: patients with an initial PHQ-9 score >9 who achieve remission at approximately 12 months, defined as a PHQ-9 score <5 at twelve months (+/- 30 days). This measure captures long-term treatment outcomes for depression and supports quality reporting and population health management nationally. It is relevant to payers and providers focused on behavioral health outcomes, care coordination, and value-based performance metrics.

Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the code’s clinical context, the typical care settings where the measure is assessed, and the implications for quality measurement and care management workflows. The publication provides benchmarks and policy considerations relevant to national payer programs and quality reporting initiatives where available. Where information is not provided in the input, the publication notes that data are not available.

This summary serves clinicians, billing staff, and payer policy analysts seeking to understand the purpose of G9393, where it is applied, and what topics to examine next when integrating this outcome measure into reporting and reimbursement frameworks.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG9393HCPCS Level IIPHQ-9depression-remissionbehavioral-healthquality-measureoutcome-measure12-month-follow-up

Billing Code Overview

HCPCS Level II code G9393 describes a patient-centered outcome measure: a patient with an initial PHQ-9 score greater than nine who achieves remission at twelve months, defined as a twelve month (+/- 30 days) PHQ-9 score of less than five.

Service type: Measurement and reporting of depression remission status at the twelve-month interval following an elevated initial PHQ-9 screening.
Typical site of service: Outpatient behavioral health or primary care settings where depression screening and follow-up assessments are performed.

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 42-year-old patient presented to a primary care clinic with symptoms of major depressive disorder and an initial Patient Health Questionnaire-9 (PHQ-9) score of 14. The clinician documents baseline symptoms, initiates an evidence-based treatment plan (psychotherapy referral and/or antidepressant medication), and schedules systematic measurement-based follow-up. At the 12-month follow-up visit (±30 days), the patient completes a PHQ-9 and scores 4, indicating remission per this measure. The clinical workflow includes: initial screening and PHQ-9 administration, documented baseline score >9, treatment initiation and periodic PHQ-9 monitoring documented in the medical record, care management or behavioral health integration notes as applicable, and a documented PHQ-9 at 12 months (+/- 30 days) showing a score <5. Typical sites of service include primary care clinics, behavioral health clinics, and outpatient integrated care settings. Common patient scenarios include adults receiving ongoing treatment for major depressive disorder who achieve symptom remission at the one-year measurement point.

Coding Specifications

Modifier	Description	When to Use

HCPCS G9833: Patient Transfer to Practice After Initiation of Chemotherapy

HCPCS-G2163-INFLUENZA-VACCINE-SEASONAL-MEASUREMENT-WINDOW

HCPCS G2163: Influenza Vaccine Received During Seasonal Measurement Window

HCPCS-G0416-PROSTATE-NEEDLE-BIOPSY-PATHOLOGY-EXAM

HCPCS G0416: Prostate Needle Biopsy Surgical Pathology

HCPCS-G9736-PATIENT-REFUSED-TO-PARTICIPATE

HCPCS G9736: Patient Refused to Participate

HCPCS-G8998-SWALLOWING-FUNCTIONAL-LIMITATION-DISCHARGE-STATUS

HCPCS G8998: Swallowing Functional Limitation, Discharge Status

HCPCS-G2012-VIRTUAL-CHECK-IN-ESTABLISHED-PATIENT

HCPCS G2012: Brief Virtual Check-In for Established Patients

HCPCS-G8908-PATIENT-BURN-DOCUMENTED-PRIOR-TO-DISCHARGE

HCPCS G8908: Patient Documented to Have Received a Burn Prior to Discharge

HCPCS-G9708-BILATERAL-MASTECTOMY-HISTORY

HCPCS G9708: Bilateral Mastectomy Status

HCPCS-G4025-PHYSICAL-MEDICINE-MIPS-SPECIALTY-SET

HCPCS G4025: Physical Medicine MIPS Specialty Set

HCPCS-G8475-ACE-ARB-THERAPY-NOT-PRESCRIBED-REASON-NOT-GIVEN

HCPCS G8475: ACE/ARB Therapy Not Prescribed, Reason Not Given

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Taxonomy Code	Specialty	Notes
`207Q00000X`	Family Medicine	Primary care providers commonly perform screening, treatment initiation, and longitudinal measurement-based care for depression.
`208D00000X`	Psychiatry	Psychiatrists manage medication, complex diagnostics, and follow-up measurement-based outcomes.
`363L00000X`	Behavioral Health & Social Service Provider	Behavioral health clinicians provide psychotherapy and measurement-based behavioral interventions.
`208000000X`	Internal Medicine	Internists in outpatient settings commonly screen and manage depressive disorders with `PHQ-9` tracking.
`362LA2200X`	Clinical Nurse Specialist - Behavioral Health	Advanced practice clinicians providing integrated behavioral health services and outcome measurement.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`F32.1`	Major depressive disorder, single episode, moderate	Common diagnosis for patients with baseline `PHQ-9` >9 and tracked for remission at 12 months.
`F32.9`	Major depressive disorder, single episode, unspecified	Used when severity not otherwise specified but monitoring with `PHQ-9` is performed.
`F33.1`	Major depressive disorder, recurrent, moderate	Recurrent depression patients frequently undergo `PHQ-9` monitoring and may achieve remission at follow-up.
`F33.9`	Major depressive disorder, recurrent, unspecified	Recurrent cases without specified severity monitored with measurement-based care.
`F34.1`	Dysthymia (persistent depressive disorder)	Chronic depressive disorders are monitored with serial `PHQ-9` scores to document remission or improvement.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`96127`	Brief emotional/behavioral assessment (e.g., `PHQ-9`), with scoring and documentation, per standardized instrument	Commonly used to bill for administration and scoring of the `PHQ-9` during primary and follow-up visits; often performed at baseline and serially including the 12-month measurement.
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutes	Typical E/M visit code used for follow-up visits where `PHQ-9` is reviewed and treatment adjusted leading to documented remission.
`99214`	Office or other outpatient visit for the evaluation and management of an established patient, typically 25 minutes	Used when follow-up requires moderate complexity decision making or additional care coordination documented alongside the `PHQ-9` outcome.
`99484`	Care management services for behavioral health conditions, per month, includes crisis prevention and follow-up	Used for ongoing behavioral health care management that supports measurement-based care and documentation across the 12-month period.
`99420`	Administration and interpretation of health risk assessment instrument (e.g., for behavioral screening)	May be used in some settings for comprehensive risk assessment processes that include `PHQ-9` tracking.
`90791`	Psychiatric diagnostic evaluation (no medical services)	Performed for initial psychiatric evaluation prior to initiation of treatment and baseline `PHQ-9` documentation when conducted by mental health specialists.

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