G9510 HCPCS – Depression 12‑Month Benchmarks & Policy | OpenPayer

Summary & Overview

HCPCS G9510: Adult Depression 12-Month Non-Remission Assessment

HCPCS Level II code G9510 documents adult patients (18+) with major depression or dysthymia who have not reached remission after 12 months, based on PHQ-9 or PHQ-9M assessment within a ±60-day window. The code captures both documented non-remission (score ≥5) and instances where the relevant assessment was not performed. Nationally, this code supports tracking long-term treatment outcomes for depressive disorders and informs quality measurement, care management, and payment policies tied to behavioral health outcomes.

Key payers covered in typical analyses include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will learn the clinical context for using G9510, the expected service setting (outpatient behavioral health or primary care), and how the code fits into longitudinal depression care pathways. The report outlines benchmarking opportunities, relevant policy interpretation for payers, and operational implications for documentation and coding workflows. Data not available in the input will be noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG9510HCPCS Level IIdepressionPHQ-9behavioral healthlongitudinal carequality measurementoutpatient

Billing Code Overview

HCPCS Level II code G9510 identifies adult patients aged 18 and older with major depression or dysthymia who have not achieved remission at twelve months, as demonstrated by a twelve month (+/-60 days) PHQ-9 or PHQ-9M score of less than 5. The description also captures situations where either the PHQ-9 or PHQ-9M score was not assessed or is greater than or equal to 5.

Service type: Measurement and follow-up assessment for depression treatment response at the 12-month mark
Typical site of service: Outpatient behavioral health or primary care settings where depression screening and longitudinal follow-up occur

Clinical & Coding Specifications

Clinical Context

A 34-year-old adult patient with a documented history of major depressive disorder presents for a twelve-month outcome assessment after initiation of an evidence-based treatment plan. The clinician reviews longitudinal treatment records, medication adherence, psychotherapy visit frequency, and longitudinal PHQ-9 or PHQ-9M screening data. At the 12-month (+/- 60 days) interval the PHQ-9/PHQ-9M score was either not assessed or is greater than or equal to 5, indicating the patient has not reached remission (remission defined as PHQ-9 < 5). The workflow includes identification of patients due for the 12-month measurement, administration or documentation of the PHQ-9/PHQ-9M, EHR capture of the score, confirmation of diagnosis (for example, F33.1 Major depressive disorder, recurrent, moderate), care team communication, and billing for the quality measure/activity represented by G9510. Typical sites of service are outpatient behavioral health clinics, primary care offices, integrated behavioral health settings, and telehealth visits where measurement-based care is documented. The typical patient scenario involves ongoing pharmacotherapy and/or psychotherapy without symptom remission at one year, prompting care-team review of treatment adequacy, adherence, and potential adjustments in therapy while documenting the required 12-month measurement or lack thereof for reporting purposes.

Coding Specifications

Modifier	Description	When to Use
`22`

HCPCS G9517: No Improvement in Visual Acuity Within 90 Days

HCPCS-G2080-ADDITIONAL-30-MINUTE-COUNSELING-MAT-WEEK

HCPCS G2080: Additional 30-Minute Counseling for Medication Assisted Treatment

HCPCS-G9420-NON-LUNG-OR-NON-PRIMARY-NSCLC-SPECIMEN-SITE

HCPCS G9420: Non-Lung or Non-Primary NSCLC Specimen Site

HCPCS-G6042-AMPHETAMINE-METHAMPHETAMINE-TESTING

HCPCS G6042: Amphetamine or Methamphetamine Testing

HCPCS-G0504-PSYCHIATRIC-COLLABORATIVE-CARE-MANAGEMENT-ADDITIONAL-30MIN

HCPCS G0504: Psychiatric Collaborative Care Management, Additional 30 Minutes

HCPCS-G0328-FECAL-OCCULT-BLOOD-IMMUNOASSAY-SCREENING

HCPCS G0328: Colorectal Cancer Screening, Fecal Occult Blood Immunoassay

HCPCS-G8544-CABG-MEASURES-REPORTING

HCPCS G8544: Intent to Report CABG Measures Group

HCPCS-G6036-IMIPRAMINE-ASSAY

HCPCS G6036: Assay of Imipramine

HCPCS-G0547-INTERPROFESSIONAL-MENTAL-HEALTH-E-CONSULT-11-20-MINUTES

HCPCS G0547: Interprofessional Mental Health E-Consult, 11–20 Minutes

HCPCS-G9695-LONG-ACTING-INHALED-BRONCHODILATOR-PRESCRIBED

HCPCS G9695: Long-Acting Inhaled Bronchodilator Prescribed

Showing 1–10 of 1996

Taxonomy Code	Specialty	Notes
`101Y00000X`	Psychiatry	Psychiatrists commonly document PHQ-9 outcomes and manage antidepressant therapy.
`2084P0800X`	Behavioral Health & Social Service Provider	Psychologists or licensed therapists who perform standardized assessments and psychotherapy.
`208000000X`	Family Medicine	Primary care clinicians frequently perform screening and longitudinal depression management.
`213E00000X`	Nurse Practitioner	NPs often manage depression treatment and document measurement-based care.
`208000000S`	Internal Medicine	Internists provide ongoing depression care and document outcome measures.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`F33.1`	Major depressive disorder, recurrent, moderate	Common diagnosis for adults in long-term treatment who fail to reach remission at twelve months and require documented PHQ-9 monitoring.
`F33.2`	Major depressive disorder, recurrent severe without psychotic features	Represents patients with more severe disease who frequently require closer measurement-based follow-up.
`F32.1`	Major depressive disorder, single episode, moderate	Applicable when the patient is in an ongoing treatment episode with persistent symptoms at 12 months.
`F34.1`	Dysthymia (persistent depressive disorder)	Chronic depressive disorder where remission at 12 months may not be achieved and measurement tracking is required.
`F32.9`	Major depressive disorder, single episode, unspecified	Used when the specific severity is not documented but the diagnosis of depression necessitates PHQ-9 monitoring.
`Z13.89`	Encounter for screening for other disorder	May be used to document a screening or measurement encounter when administrative capture of PHQ-9 is required.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`96127`	Brief emotional/behavioral assessment (e.g., depression inventory), with scoring and documentation, per standardized instrument	Often used for administration and scoring of brief depression screens like the PHQ-9 in the same visit where `G9510` measurement status is documented.
`99406`	Smoking and tobacco use cessation counseling visit, intermediate, greater than 3 minutes up to 10 minutes	Behavioral counseling codes such as this may be performed during the same visit but are separate services; listed as an example of commonly paired counseling services.
`90834`	Psychotherapy, 45 minutes with patient	Psychotherapy sessions commonly occur before or after the 12-month measurement and are part of ongoing treatment when remission is not achieved.
`99213`	Office or other outpatient visit for evaluation and management, typically 15 minutes	Typical E/M visit code used by primary care or psychiatry to document the clinical encounter associated with measurement reporting.
`99492`	Initial psychiatric collaborative care management, first 70 minutes in the first calendar month	Collaborative care model codes may be used in integrated care settings alongside measurement-based care documentation when depression treatment is ongoing.

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