G9573 HCPCS Reimbursement & Policy | OpenPayer

Summary & Overview

HCPCS G9573: Adult Depression Six-Month Nonremission (PHQ-9/PHQ-9M)

HCPCS Level II code G9573 denotes adults (age 18+) with major depressive disorder or dysthymia who have not reached remission at six months, as evidenced by a six month (+/-60 days) PHQ-9 or PHQ-9M score of less than five. The code captures a clinically significant outcome used in measurement-based care to document persistent depressive symptoms despite treatment, informing care management and quality reporting nationally. Its use reflects ongoing emphasis on routine standardized screening and outcome tracking in behavioral health.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find benchmarks and policy context around use of measurement-based depression outcome codes, typical sites of service for documentation, and implications for coding workflows and quality reporting. The publication outlines clinical context for the PHQ-9/PHQ-9M six-month assessment, common billing considerations, and where data are available versus where input data are not provided. This summary is intended for a national audience of clinicians, coding professionals, and policy analysts seeking concise guidance on the purpose and application of HCPCS Level II code G9573 in behavioral health performance measurement.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG9573HCPCS Level IIdepressionPHQ-9measurement-based carebehavioral healthoutcome assessmentquality reporting

Billing Code Overview

HCPCS Level II code G9573 applies to adult patients (18 years and older) with major depression or dysthymia who have not achieved remission at six months, as demonstrated by a six month (+/-60 days) PHQ-9 or PHQ-9M score of less than five. The code documents a measurement-based care outcome indicating persistence of depressive symptoms at the six-month assessment.

Service type: Measurement-based depression outcome assessment and documentation tied to six-month symptom evaluation
Typical site of service: Outpatient behavioral health or primary care settings where routine depression screening and follow-up using the PHQ-9/PHQ-9M are performed

Clinical & Coding Specifications

Clinical Context

A 42-year-old adult patient with a history of major depressive disorder presents for a six-month follow-up after initiation of antidepressant therapy and psychotherapy. The clinic documents serial PHQ-9 or PHQ-9M scores at baseline and follow-up visits. At the six-month measurement window (six months ±60 days) the patient’s PHQ-9 score remains 8, indicating persistent depressive symptoms and failure to reach remission (remission defined as a score <5). The treating psychiatrist or primary care physician documents ongoing symptoms, medication adherence, side effects, any dosage adjustments, and plans for treatment optimization such as medication change, augmentation, psychotherapy referral, or specialty mental health consultation. Typical workflow includes: scheduling the six-month outcome assessment, administering and scoring the PHQ-9/PHQ-9M, documenting the score and clinical interpretation in the medical record, updating the problem list with major depressive disorder and relevant ICD-10 codes, and billing the HCPCS Level II code G9573 to indicate an adult patient (≥18 years) with major depression/dysthymia who did not reach remission at six months as demonstrated by a PHQ-9/PHQ-9M score <5 within the specified window. Typical sites of service are outpatient behavioral health clinics, primary care offices, psychiatry practices, community mental health centers, and integrated care clinics that perform outcome measurement and follow-up.

Coding Specifications

Modifier

HCPCS G8566: Not Eligible for Otologic Evaluation Referral Measure

HCPCS-G9294-PATHOLOGY-REPORT-THICKNESS-ULCERATION-MITOTIC-RATE

HCPCS G9294: Pathology Report Documenting Thickness, Ulceration, and Mitotic Rate

HCPCS-G8535-ELDER-MALTREATMENT-SCREEN-NOT-DOCUMENTED

HCPCS G8535: Elder Maltreatment Screen Not Documented

HCPCS-G9407-FOLLOW-UP-NOT-RECEIVED-WITHIN-7-DAYS-AFTER-DISCHARGE

HCPCS G9407: Patient Did Not Receive Follow-Up Within 7 Days After Discharge

HCPCS-G9849-PATIENTS-DIED-FROM-CANCER

HCPCS G9849: Patients Who Died From Cancer

HCPCS-G0320-HOME-HEALTH-TELEMEDICINE-SYNCHRONOUS-AUDIO-VIDEO

HCPCS G0320: Home Health Services via Synchronous Audio-Video Telemedicine

HCPCS-G9051-ONCOLOGY-TREATMENT-DECISION-MAKING

HCPCS G9051: Oncology Treatment Decision-Making Visit

HCPCS-G8948-NO-NEUROPSYCHIATRIC-SYMPTOMS

HCPCS G8948: No Neuropsychiatric Symptoms

HCPCS-G2065-COMPREHENSIVE-CARE-MANAGEMENT-SINGLE-HIGH-RISK-DISEASE

HCPCS G2065: Comprehensive Care Management for Single High-Risk Chronic Disease

HCPCS-G9097-ESOPHAGEAL-CANCER-T4-INITIAL-DISEASE-STATUS

HCPCS G9097: Esophageal Cancer Initial Disease-Status (t4, any n, m0)

Showing 1–10 of 1996

`22`	Increased procedural services	Use when services required substantially greater work than typical for the visit due to complexity of psychiatric management or extended documentation related to non-remission.
`23`	Unusual anesthesia	Rarely applicable; only if an unusual anesthesia event occurs during a concurrent procedure billed on the same date.
`52`	Reduced services	Use when the full scope of the service was reduced or not completed.
`53`	Discontinued procedure	Use when an intended service was started but discontinued for patient safety or other valid reasons.
`54`	Surgical care only	Not typically applicable to this code; include if surgical provider bills only the surgical portion in a related encounter.
`55`	Postoperative management only	Not typically applicable; used when only postoperative care is billed by a provider.
`56`	Preoperative management only	Not typically applicable; used when only preoperative care is billed by a provider.
`62`	Two surgeons	Rare for this code; used when two surgeons share responsibility for a surgical procedure billed concurrently.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery	Not typical; included when advanced practice clinicians assist in a surgical procedure billed same day.
`CO`	Service provided by a resident in a teaching hospital with no attending present	Use when a resident provides the service without direct attending involvement and billing requirements allow this modifier.
`CQ`	Service furnished by a physical therapist in a therapy cap instance	Not typical for behavioral health; included only if physical therapy services are involved concurrently and require CQ.
`FX`	Split/shared E/M by part-time physician	Use when service is split/shared between multiple physicians and billing rules require this modifier.
`FY`	Split/shared E/M by full-time physician	Use when service is split/shared between full-time physicians under applicable payer policies.
`QK`	Medical direction of two, three, or four trainees performing services	Use in teaching settings when the physician directs multiple residents or trainees delivering the service.
`QX`	CRNA service with medical direction by physician	Use only if a CRNA provides anesthesia services that relate to a concurrent procedure.

Taxonomy Code	Specialty	Notes
`2084P0800X`	Psychiatry	Psychiatrists commonly document and manage major depressive disorder and outcome measurements.
`208000000X`	Family Medicine	Primary care physicians frequently perform depression screening and ongoing management with PHQ-9 monitoring.
`2086P0800X`	Clinical Social Worker	Clinical social workers provide psychotherapy and collaborate in measurement-based care.
`364S00000X`	Behavioral Health Counselor	Behavioral health counselors perform PHQ-9 assessments and therapy interventions in outpatient settings.
`103T00000X`	Psychologist	Psychologists administer standardized outcome measures and provide psychotherapy and assessment services.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`F32.1`	Major depressive disorder, single episode, moderate	Common diagnosis associated with ongoing depressive symptoms assessed by `PHQ-9` at six months.
`F32.2`	Major depressive disorder, single episode, severe without psychotic features	Represents more severe depression where remission failure at six months is clinically significant.
`F33.1`	Major depressive disorder, recurrent, moderate	Recurrent depression patients commonly undergo measurement-based care and may not reach remission at six months.
`F33.2`	Major depressive disorder, recurrent severe without psychotic features	Indicates recurrent severe illness with high relevance for treatment adjustment when `PHQ-9` scores remain elevated.
`F34.1`	Dysthymia (persistent depressive disorder)	Chronic, lower-grade depressive disorder included in the billing code description and relevant for six-month outcome tracking.
`Z13.89`	Encounter for screening for other disorder	Used when documenting screening and outcome measurement activities such as `PHQ-9` administration.
`Z71.9`	Counseling, unspecified	May be coded when counseling or psychotherapy elements are part of the visit addressing non-remission.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99406`	Smoking and tobacco use cessation counseling, intermediate, greater than 3 minutes up to 10 minutes	May be performed during the same visit when addressing behavioral health risk factors that affect depression treatment outcomes.
`99407`	Smoking and tobacco use cessation counseling, intensive, greater than 10 minutes	Applicable if intensive counseling is provided in the visit addressing contributing behaviors.
`96127`	Brief emotional/behavioral assessment (e.g., depression inventory), per standardized instrument	Commonly used to bill administration/scoring of brief standardized instruments such as the `PHQ-9` when billed separately.
`90834`	Psychotherapy, 45 minutes with patient and/or family member	Frequently provided alongside outcome measurement when psychotherapy is delivered or adjusted due to non-remission.
`99214`	Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity	Often used by primary care or psychiatry clinicians for a follow-up visit that includes treatment adjustment for persistent depression.
`99215`	Office or other outpatient visit for the evaluation and management of an established patient, high complexity	Used when the encounter requires high medical decision-making or extensive management for refractory depression.

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