M1019 HCPCS: Reimbursement & Benchmarks | OpenPayer

Summary & Overview

HCPCS M1019: Adolescent Depression Remission at 12 Months

HCPCS Level II code M1019 denotes adolescents ages 12–17 with major depression or dysthymia who achieved remission at 12 months, defined by a PHQ-9 or PHQ-9M score below 5 within a ±60-day window. As a standardized outcome measure, this code captures sustained clinical improvement and supports quality reporting and performance measurement across behavioral health and primary care settings. Nationally, tracking adolescent depression remission is a priority for payers and health systems seeking to demonstrate effective treatment and continuity of care.

Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an explanation of the code's clinical intent, the typical service context (outpatient behavioral health or primary care follow-up assessments), and the kinds of benchmarks and reporting use cases this measure informs. The publication outlines how M1019 is used within quality measurement frameworks, common reporting pathways, and implications for clinical operations and documentation workflows. Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes is noted where relevant.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareM1019HCPCS Level IIadolescent depressionPHQ-9behavioral healthremission measurequality reportingoutcome measure

Billing Code Overview

HCPCS Level II code M1019 identifies adolescent patients ages 12 to 17 with major depression or dysthymia who have reached remission at twelve months, as demonstrated by a twelve month (+/-60 days) PHQ-9 or PHQ-9M score of less than 5. This measure reflects a clinical outcome tied to standardized depression symptom screening and follow-up assessment.

Service type: Measurement of clinical remission for adolescent major depression/dysthymia using standardized symptom scales
Typical site of service: Outpatient behavioral health or primary care settings where follow-up PHQ-9/PHQ-9M assessment is completed

Clinical & Coding Specifications

Clinical Context

A 15-year-old adolescent male with a history of major depressive disorder began treatment in an outpatient pediatric behavioral health clinic. Initial PHQ-9A screening documented moderate-to-severe depressive symptoms. Treatment included psychotherapy and a selective serotonin reuptake inhibitor managed by a child and adolescent psychiatrist in collaboration with the patient’s primary care pediatrician. Over twelve months of treatment there were regular follow-up visits, medication management, and quarterly PHQ-9A or PHQ-9M monitoring. At the twelve-month (+/- 60 days) assessment the PHQ-9 score was documented as 3, indicating remission. The clinical workflow for reporting this HCPCS Level II measure includes verification of patient age (12–17 years), confirmation of primary diagnosis of major depression or dysthymia in the chart problem list, documentation of the twelve-month PHQ-9 or PHQ-9M result (<5) dated within the allowed window, and submission of the M1019 measure to the payor or quality registry. Typical encounters involve face-to-face outpatient visits in a psychiatric clinic or integrated primary care behavioral health setting, with supporting documentation in progress notes, medication lists, and structured outcome forms.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when additional work beyond the usual is documented for visits or care coordination related to complex adolescent depression (e.g., extensive coordination with schools, family systems, or multiple comorbidities).

HCPCS Level II M1065: Shingrix Vaccine Not Administered, Documented Reason

HCPCS-M1034-180-DAYS-OPIOID-USE-DISORDER-PHARMACOTHERAPY-CONTINUITY

HCPCS M1034: 180-Day Continuous Pharmacotherapy for Opioid Use Disorder

HCPCS-M1070-PATIENT-NOT-SCREENED-FALL-RISK

HCPCS Level II M1070: Patient Not Screened for Future Fall Risk

HCPCS-M1024-ADOLESCENT-DEPRESSION-NONREMISSION-6-MONTHS

HCPCS M1024: Adolescent Depression Nonremission at Six Months

HCPCS-M1048-OSWESTRY-DISABILITY-INDEX-PRE-POST-OP-ASSESSMENT

HCPCS M1048: Oswestry Disability Index Preoperative and 3-Month Postoperative Assessment

HCPCS-M1059-HOSPICE-OR-PALLIATIVE-CARE-STATUS

HCPCS Level II M1059: Hospice or Palliative Care Status

HCPCS-M1039-LUMBAR-SPINE-INFECTION-PROCEDURE

HCPCS Level II M1039: Lumbar Spine Region Infection at Procedure Time

HCPCS-M1042-OSWESTRY-DISABILITY-INDEX-PREOP-POSTOP

HCPCS Level II M1042: Oswestry Disability Index Preop and 1-Year Postop

HCPCS-M1033-PHARMACOTHERAPY-INITIATION-OPIOID-USE-DISORDER

HCPCS Level II M1033: Pharmacotherapy Initiation for Opioid Use Disorder

HCPCS-M1049-POSTOPERATIVE-FUNCTIONAL-STATUS-ODI-NOT-MEASURED

HCPCS M1049: ODI Not Measured at Three-Month Postoperative Assessment

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Taxonomy Code	Specialty	Notes
`2084P0800X`	Child and Adolescent Psychiatry	Most common specialty overseeing diagnosis, medication management, and remission assessment.
`208000000X`	General Psychiatry	Provides psychiatric diagnosis and longitudinal treatment for adolescents when subspecialty psychiatry is not available.
`261QM2500X`	Clinical Social Work	Provides psychotherapy and outcome monitoring in many outpatient settings.
`207Q00000X`	Family Medicine	Often manages depression in adolescents in primary care with coordination for specialty referral.
`363L00000X`	Clinical Nurse Specialist - Psychiatry	Provides medication management and care coordination in behavioral health programs.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`F32.0`	Major depressive disorder, single episode, mild	Represents a common diagnosis in adolescents tracked for remission at 12 months.
`F32.1`	Major depressive disorder, single episode, moderate	Clinical severity category commonly monitored with serial PHQ-9 scores.
`F32.2`	Major depressive disorder, single episode, severe without psychotic features	Higher severity requiring close monitoring; remission defined by PHQ-9 <5 at twelve months.
`F33.0`	Major depressive disorder, recurrent, mild	Recurrent depressive episodes are included in longitudinal outcome tracking.
`F33.1`	Major depressive disorder, recurrent, moderate	Recurrent moderate depression is a target population for the `M1019` measure.
`F34.1`	Dysthymia (persistent depressive disorder)	Chronic, persistent depressive symptoms tracked over time with PHQ-9/PHQ-9M to document remission.
`F32.9`	Major depressive disorder, single episode, unspecified	Used when documentation supports depression diagnosis but specifics are not coded; still relevant for remission measurement.

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	Commonly used to bill brief depression screening or outcome measures administered during follow-up visits; complements the PHQ-9/PHQ-9M data used for `M1019`.
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutes	Frequently used for routine medication management and psychotherapy-focused follow-up visits during the 12-month treatment period.
`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 requiring moderate to high medical decision-making or extensive coordination.
`90834`	Psychotherapy, 45 minutes with patient and/or family	Used when psychotherapy sessions are provided as part of the treatment plan leading to remission; documentation supports the `M1019` outcome.
`90791`	Psychiatric diagnostic evaluation (no medical services)	Commonly used at intake to establish diagnosis of major depression or dysthymia prior to longitudinal tracking that culminates in the 12-month remission measurement.

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