HCPCS G9574: Six-Month Assessment for Depression Remission

HCPCS Level II code G9574 denotes a six-month treatment outcome assessment for adults (age 18+) diagnosed with major depression or dysthymia who have not achieved remission. The code is used when a six-month (+/-60 days) PHQ-9 or PHQ-9M indicates a score of five or higher, or when the instrument was not assessed, signaling incomplete or inadequate treatment response. This code matters nationally as payers and providers increasingly track longitudinal depression outcomes to monitor care quality and value-based performance.

Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the code's clinical intent, the typical ambulatory settings where it is used, and the types of analyses and benchmarks commonly associated with six-month depression outcome measures. The publication outlines how G9574 fits into depression monitoring workflows, highlights payer coverage relevance, and identifies the operational contexts—such as outpatient behavioral health and primary care—where the code is most applicable. Data not provided in the input (for example, specific ICD-10 pairings or taxonomy details) are noted as unavailable.

Billing Code Overview

HCPCS Level II code G9574 applies to adult patients age 18 and older with major depression or dysthymia who have not reached remission at six months, as demonstrated by a six month (+/-60 days) PHQ-9 or PHQ-9M score of less than five; alternatively, the PHQ-9 or PHQ-9M score was not assessed or is greater than or equal to five. This code captures a clinical assessment point focused on treatment response at six months for depressive disorders.

Service type: Mental health outcome assessment related to depression treatment at six months
Typical site of service: Outpatient behavioral health clinics, primary care offices, or other ambulatory settings where PHQ-9 or PHQ-9M monitoring is performed

Data not available in the input.

Clinical Context

An adult patient, age 18 or older, with a diagnosed major depressive disorder or dysthymia presents for routine follow-up at six months after initiation of treatment. The clinic uses the Patient Health Questionnaire-9 (PHQ-9 or PHQ-9M) to assess symptom severity and remission status. At the six-month visit (allowable window ±60 days) the PHQ-9 score is obtained and documented. The billing code G9574 is applied when the patient has not reached remission by six months, defined as a PHQ-9 or PHQ-9M score of five or greater, or when the PHQ-9/PHQ-9M was not administered or not documented in the allowable window.

A typical clinical workflow:

Initial diagnosis and treatment planning for major depressive disorder or dysthymia, with baseline PHQ-9.
Ongoing treatment (psychotherapy, pharmacotherapy, care management) with periodic outcome measurement.
At approximately six months after treatment initiation (±60 days), clinician or behavioral health staff administers and scores the PHQ-9/PHQ-9M and documents results in the medical record.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when additional work beyond the typical service is documented (e.g., extensive counseling or care coordination documented at the six-month visit).
`23`	Unusual anesthesia	Not typically applicable but included per standard lists; use only if unusual anesthesia is provided.
`52`	Reduced services	Use when the service is partially reduced or discontinued at the six-month assessment visit.
`53`	Discontinued procedure	Use if the planned assessment or service was started but terminated due to extenuating circumstances.
`54`	Surgical care only	Not typically applicable to this behavioral health assessment.
`55`	Postoperative management only	Not typically applicable to this code.
`56`	Preoperative management only	Not typically applicable to this code.
`62`	Two surgeons	Not applicable to this nonprocedural assessment unless two independent clinicians bill concurrently.
`AS`	Ambulatory surgical center (ASC) payment status modifier	Use when reporting services furnished in an ASC setting if applicable.
`CO`	Worker’s compensation (state or federal)	Use when the claim is related to a workers’ compensation payer.
`CQ`	Service furnished under arrangement of a CRNA by an anesthesiologist	Not typically applicable; included per provided list.
`FX`	No standard Medicare definition; use per payer instruction	Use only if specific payer recognizes this modifier for administrative reasons.
`FY`	Distinct reporting modifier (payer-specific)	Use per payer-specific guidance when needed.
`QK`	Medical direction of two, three, or four concurrent anesthesia cases involving qualified individuals	Not applicable to this assessment visit.
`QX`	CRNA service: medically directed by a physician	Not applicable to this assessment visit.

Taxonomy Code	Specialty	Notes
`207Q00000X`	Psychiatry	Psychiatrists commonly perform diagnostic assessment and medication management and document `PHQ-9` results.
`2084P0800X`	Behavioral Health & Social Service Providers	Psychologists or licensed therapists perform symptom measurement and psychotherapy.
`101Y00000X`	Physician Assistant	Physician assistants may manage follow-up and outcome measurement.
`363L00000X`	Clinical Social Worker	Clinical social workers provide psychotherapy and care coordination and document `PHQ-9` scores.
`208D00000X`

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`F32.0`	Mild depressive episode	Common diagnosis for adults treated and monitored with `PHQ-9` scores.
`F32.1`	Moderate depressive episode	Used when depressive symptoms are more pronounced and tracked for remission.
`F32.2`	Severe depressive episode without psychotic symptoms	Higher severity diagnosis; remission status at six months is clinically relevant.
`F33.0`	Major depressive disorder, recurrent, single episode, mild	Recurrent depression cases monitored for remission at six months.
`F33.1`	Major depressive disorder, recurrent, moderate	Used for recurrent episodes where outcome measurement informs ongoing care.
`F34.1`	Dysthymia (persistent depressive disorder)	Chronic depressive disorder included in the `G9574` definition; tracked with `PHQ-9`.
`F32.9`	Major depressive disorder, single episode, unspecified	Used when documentation lacks full severity specifiers but remission monitoring is performed.
`F33.9`	Major depressive disorder, recurrent, unspecified	Used for recurrent depression without specified severity; relevance to six-month remission.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99402`	Preventive medicine counseling, 30 minutes	May be used for timed psychotherapy or counseling provided during follow-up visits addressing treatment nonremission.
`99407`	Smoking and tobacco use cessation counseling, intensive	Not specific to depression but may be used in concurrent behavioral interventions when tobacco use counseling is provided.
`90834`	Psychotherapy, 45 minutes with patient	Common psychotherapy code used before or after the six-month assessment when therapy is delivered.
`99214`	Office or other outpatient visit for established patient, moderate complexity	Typical E/M code for a follow-up visit where medication adjustments and `PHQ-9` review occur.
`96127`	Brief emotional/behavioral assessment (e.g., `PHQ-9`), with scoring and documentation, per standardized instrument	Frequently used to report administration and scoring of `PHQ-9` when billed separately alongside the visit.
`99484`	Care management services for behavioral health conditions, per calendar month	Used when ongoing care management for depression is furnished in the treatment period including outcomes monitoring.

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Summary & Overview