G9396 HCPCS PHQ‑9 Reimbursement & Policy | OpenPayer

Summary & Overview

HCPCS G9396: PHQ-9 >9, No 12-Month Remission Assessment

HCPCS Level II code G9396 denotes patients with an initial PHQ-9 score >9 who were not assessed for remission at approximately 12 months. Nationally, this code functions as a quality measure flag tied to depression care continuity and outcomes monitoring; it highlights gaps in longitudinal assessment rather than a billable treatment procedure. The code matters because regular depression follow-up is linked to improved clinical outcomes and is monitored by payers and health systems aiming to close care gaps.

Key payers in the coverage landscape include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find concise context on the clinical meaning of the code, the service setting where it is typically used, and what the code signals about care processes. The publication outlines benchmarks and reporting implications where available, summarizes relevant policy considerations affecting quality measurement, and situates G9396 within clinical workflows for depression screening and longitudinal monitoring. The content is designed for clinicians, coding staff, and policy analysts seeking a national-level understanding of how G9396 is used as an indicator of missed remission assessment at the 12-month interval.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG9396HCPCS Level IIPHQ-9depression screeningquality measurebehavioral healthoutpatient carefollow-up assessmentremission monitoring

Billing Code Overview

HCPCS Level II code G9396 indicates a patient who had an initial Patient Health Questionnaire-9 (PHQ-9) score greater than nine and was not assessed for remission at twelve months (+/- 30 days). This measure reflects follow-up assessment of depression symptom remission after an initial elevated PHQ-9 screening.

Service type: Mental health outcomes assessment / quality measure
Typical site of service: Outpatient behavioral health or primary care settings where depression screening and follow-up monitoring occur

Clinical & Coding Specifications

Clinical Context

A patient initially screened positive for depression in primary care with a baseline PHQ-9 score >9. The patient was started on treatment (behavioral health referral, medication, or collaborative care) and is due for a 12-month remission assessment (12 months ± 30 days from the initial positive screen). Typical workflow: at the 12-month interval the primary care clinician or behavioral health clinician administers the PHQ-9 to assess remission; scores ≤4 typically indicate remission, scores 5–9 indicate minimal symptoms, and higher scores suggest ongoing depressive symptoms requiring treatment adjustment. The billing code G9396 is reported when the patient had an initial PHQ-9 >9 but was not assessed for remission during the 12-month window. Typical site of service is an outpatient primary care clinic or outpatient behavioral health clinic. A realistic patient scenario: a 52-year-old established patient with an initial PHQ-9 score of 14 initiated on an SSRI and scheduled for follow-up; at the 12-month anniversary the patient missed the clinic visit and no PHQ-9 was documented within the ±30-day window, so G9396 is reported to indicate the missed 12-month remission assessment.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work required is substantially greater than typically required for reporting the service associated with this code.

HCPCS G0444: Annual Depression Screening, 5–15 Minutes

HCPCS-G8660-LOW-BACK-IMPAIRMENT-RESIDUAL-SCORE-NEGATIVE

HCPCS G8660: Low Back Impairment Residual Score Less Than Zero

HCPCS-G9450-HISTORY-INJECTION-DRUG-USE

HCPCS G9450: History of Injection Drug Use

HCPCS-G9938-INSTITUTIONAL-SNP-LONG-TERM-CARE-RESIDENCY-66-PLUS

HCPCS G9938: Institutional SNP Enrollment and Long-Term Care Residency, Age 66+

HCPCS-G8768-MEDICAL-REASON-NO-LIPID-PROFILE

HCPCS G8768: Medical Reason for Not Performing Lipid Profile

HCPCS-G0422-INTENSIVE-CARDIAC-REHABILITATION-SESSION

HCPCS G0422: Intensive Cardiac Rehabilitation Session

HCPCS-G0101-CERVICAL-VAGINAL-CANCER-SCREENING-PELVIC-BREAST-EXAM

HCPCS G0101: Cervical or Vaginal Cancer Screening with Pelvic and Clinical Breast Exam

HCPCS-G8631-PROPHYLACTIC-ANTIBIOTIC-INELIGIBILITY-DOCUMENTATION

HCPCS G8631: Documentation of Ineligibility for Prophylactic Parenteral Antibiotics

HCPCS-G0683-LARGE-SKIN-SUBSTITUTE-GRAFT-APPLICATION

HCPCS G0683: Application of Non‑Sheet Skin Substitute Graft, ≥100 sq cm

HCPCS-G9361-MEDICAL-INDICATION-EARLY-CESAREAN-OR-INDUCTION

HCPCS G9361: Medical Indication for Early Cesarean or Induction

Showing 1–10 of 1996

Taxonomy Code	Specialty	Notes
`207Q00000X`	Family Medicine	Primary care clinicians who commonly perform screening and 12-month follow-up for depression.
`208D00000X`	Psychiatry	Psychiatrists who manage depression treatment and document remission assessments.
`363L00000X`	Behavioral Health Counseling & Therapy	Licensed therapists or clinical social workers who administer PHQ-9 and document outcomes.
`2084P0800X`	Child & Adolescent Psychiatry	When adolescent patients are in scope for the same measure.
`103T00000X`	Clinical Nurse Specialist	CNSs in psychiatric or primary care roles who may perform assessments.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`F32.9`	Major depressive disorder, single episode, unspecified	Common diagnosis for patients with an initial PHQ-9 >9 requiring follow-up and remission assessment.
`F33.1`	Major depressive disorder, recurrent, moderate	Relevant when depression is recurrent and requires routine remission monitoring at 12 months.
`F32.1`	Major depressive disorder, single episode, moderate	Applicable for patients whose baseline PHQ-9 indicates moderate depression and need 12-month reassessment.
`F43.21`	Adjustment disorder with depressed mood	Used for depressive symptoms related to identifiable stressors where remission assessment at intervals may be tracked.
`R45.851`	Suicidal ideation	Important to document alongside PHQ-9 results; influences clinical urgency and follow-up even at 12 months.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`96127`	Brief emotional/behavioral assessment (e.g., depression inventory, such as PHQ-9), with scoring and documentation, per standardized instrument	Directly used to document PHQ-9 at baseline and at 12-month remission assessment.
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutes	Common visit code for primary care follow-up visits where PHQ-9 assessment would be performed and documented.
`99214`	Office or other outpatient visit for the evaluation and management of an established patient, typically 25 minutes	Used for more complex follow-up visits addressing treatment adjustment and detailed documentation.
`90791`	Psychiatric diagnostic evaluation (no medical services)	May be used when an initial psychiatric diagnostic evaluation leads to diagnosis and treatment planning documented with PHQ-9 baseline.
`99492`	Initial psychiatric collaborative care management, first month	Used in collaborative care models where behavioral health care management includes ongoing PHQ-9 monitoring and remission assessment.

OpenPayer