Summary & Overview
HCPCS G9572: Index Date PHQ Score Greater Than 9
HCPCS Level II code G9572 indicates that a patient’s index date PHQ score was greater than 9 during the designated twelve-month denominator identification period. This code captures documentation of clinically meaningful depressive symptoms and is used in quality measurement and reporting frameworks focused on behavioral health screening and follow-up. Nationally, standardized recording of elevated PHQ scores supports population health management, performance measurement, and pay-for-performance reporting related to depression care.
Key payers commonly referenced for coverage and quality programs include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. These payers participate in initiatives that rely on consistent clinical documentation of screening results for reporting and quality incentives.
Readers will learn what G9572 represents clinically and operationally, how it functions within quality measurement, and what benchmarks and policy considerations typically surround elevated PHQ documentation. The publication includes national context on measurement use, typical sites of service, and implications for reporting and data capture. Data not available in the input: specific payer policy details, common modifiers, associated taxonomies, ICD-10 diagnoses, related codes, and service line information.
Billing Code Overview
HCPCS Level II code G9572 documents an Index date PHQ-score greater than 9 recorded during the twelve-month denominator identification period. The code indicates that, on the index date, the patient had a Patient Health Questionnaire (PHQ) score exceeding 9, consistent with moderate to severe depressive symptom burden.
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Service type: Mental health symptom severity assessment captured for quality measurement and reporting
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Typical site of service: Outpatient clinic or ambulatory care setting where standardized depression screening is performed
Clinical & Coding Specifications
Clinical Context
A primary care clinic performs annual depression screening for adult patients as part of quality measurement and population health management. A 45-year-old patient presents for a routine visit and completes the Patient Health Questionnaire-9 (PHQ-9) while rooming. The clinician documents an initial (index) PHQ-9 score of 12 during the 12‑month denominator identification period. The medical record includes the date of the PHQ-9 administration, the score, and follow-up documentation such as assessment, brief counseling, and plan. The workflow typically includes: nursing staff administers and records the PHQ-9, the electronic health record flags scores >9, the clinician reviews the score, documents clinical interpretation and next steps, and care coordination or referral is initiated when indicated. This documentation supports the billing code G9572 which captures an index date PHQ-score greater than 9 documented during the twelve month denominator identification period.
Coding Specifications
| Modifier | Description | When to Use |
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25 | Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service | Use when a significant E/M visit is provided in addition to services on the same day (e.g., extended depression assessment beyond screening). |