Summary & Overview
HCPCS G9395: PHQ-9 12-Month Nonremission
HCPCS Level II code G9395 designates patients who began with a PHQ-9 score above nine and did not achieve remission at twelve months, defined as a twelve month (+/- 30 days) PHQ-9 score of five or higher. This quality-oriented code identifies long-term depressive symptoms and supports measurement-based care tracking across ambulatory and integrated behavioral health settings. Nationally, such measures inform population health management, care coordination, and value-based payment models that emphasize symptom remission over time.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical purpose of the code, typical sites of service, and the types of benchmarks and policy context relevant to its use. The publication outlines commonly reported benchmarks for longitudinal depression outcomes, explains where this code fits in performance measurement and value-based programs, and summarizes recent policy trends that affect billing and reporting for depression outcome measures.
This summary serves clinicians, coding specialists, and policy analysts seeking a national-level briefing on G9395, including its role in tracking remission at one year and implications for quality measurement and care management.
Billing Code Overview
HCPCS Level II code G9395 describes a patient population with an initial PHQ-9 score greater than nine who did not achieve remission at twelve months, defined as a twelve month (+/- 30 days) PHQ-9 score greater than or equal to five. This code is used to identify ongoing depressive symptomatology at the one-year follow-up after an initial elevated screening.
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Service type: Longitudinal depression outcome assessment and monitoring
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Typical site of service: Outpatient behavioral health clinics, primary care offices with behavioral health integration, and other ambulatory care settings
Clinical & Coding Specifications
Clinical Context
A 42-year-old primary care patient was screened at treatment initiation with a Patient Health Questionnaire-9 (PHQ-9) and recorded an initial score of 14, indicating moderate depression. Over the course of a behavioral health or collaborative care treatment plan the patient received psychotherapy, medication management, and periodic PHQ-9 assessments. At the twelve-month follow-up (scheduled within ±30 days of the 12-month anniversary), the PHQ-9 score was 5, meeting the measurement threshold in G9395 for failure to achieve remission (initial PHQ-9 > 9 and 12-month PHQ-9 ≥ 5).
Workflow steps:
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The primary care clinician or behavioral health team documents baseline PHQ-9 and treatment plan in the medical record.
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Interventions (psychotherapy visits, psychiatry consultation, antidepressant management) are delivered and documented during the 12-month treatment window.
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A PHQ-9 is administered at the 12-month visit (allowed window ±30 days), scored, and entered into the chart.
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Coding and billing staff verify that the initial PHQ-9 met the >9 threshold and that the 12-month PHQ-9 is ≥5 before reporting
G9395. -
Clinical documentation includes dates of the initial and 12-month PHQ-9, scores, treatments provided during the 12 months, and clinician signatures to support quality reporting and claims submission.
Typical site of service: outpatient primary care clinic, behavioral health clinic, or integrated care setting where longitudinal depression management and PHQ-9 monitoring occur.
Typical patient scenario: an adult receiving longitudinal depression care who improved but did not achieve remission by 12 months, prompting continued treatment or care plan adjustments.