M1023 HCPCS: Reimbursement & Benchmarks | OpenPayer

Summary & Overview

HCPCS M1023: Adolescent Depression Remission at Six Months

HCPCS Level II code M1023 represents a measure for adolescent patients aged 12–17 with major depression or dysthymia who have achieved remission at six months, operationalized as a six month (+/-60 days) PHQ-9 or PHQ-9M score below five. Nationally, measurement of remission in adolescent depression is a quality signal used by payers and providers to track treatment effectiveness and long-term outcomes. Capturing remission at the six-month interval supports value-based care initiatives and informs care coordination between primary care and behavioral health.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical definition embedded in the code, typical service settings where the measure is documented, and the contexts in which the code is applied. The publication outlines benchmarks and reporting uses of M1023, summarizes relevant policy trends affecting behavioral health outcome measurement, and situates the code within quality measurement frameworks for adolescent depression. Data not available in the input is noted where applicable, and the content focuses on national implications rather than state-specific rules.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareM1023HCPCS Level IIadolescent depressionPHQ-9behavioral healthquality measureremissionoutcome assessment

Billing Code Overview

HCPCS Level II code M1023 documents adolescent patients (ages 12–17) with major depression or dysthymia who reached remission at six months, defined as a six month (+/-60 days) PHQ-9 or PHQ-9M score of less than five. This measure captures clinical response for pediatric depressive disorders over a six-month follow-up period.

Service type: Behavioral health follow-up / depression outcome assessment

Typical site of service: Outpatient behavioral health settings, including pediatric or adolescent psychiatry clinics, community mental health centers, and primary care clinics delivering integrated behavioral health services.

Clinical & Coding Specifications

Clinical Context

An adolescent patient, age 15, diagnosed with major depressive disorder presents for a six-month follow-up assessment after initiation of psychotherapy and/or pharmacotherapy. At the index visit the patient had a baseline PHQ-9/PHQ-9M score consistent with moderate-to-severe depression and began a treatment plan with a child/adolescent psychiatrist, pediatrician, or licensed mental health clinician. The clinical workflow for the six-month remission assessment includes scheduling an outcome measurement visit at approximately six months (±60 days) from treatment initiation; administration and scoring of the PHQ-9 or adolescent-adapted PHQ-9m; documentation of the score, treatment history, medication adherence, side effects, psychosocial stressors, and functional status; and clinician determination that the score is <5 indicating remission. The service is delivered in outpatient behavioral health or pediatric primary care settings and documented in the medical record to support billing of M1023 for adolescent patients aged 12–17 who reached remission at six months.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when the work required to document the six-month remission assessment is substantially greater than typical (rare for this code).

HCPCS Level II M1036: Adults Without 180 Days Continuous OUD Pharmacotherapy

HCPCS-M1004-DOCUMENTATION-REASON-NOT-SCREENING-TB

HCPCS M1004: Documentation of Medical Reason for Not Screening for TB

HCPCS-M1026-HOSPICE-STATUS-ANY-TIME-DURING-PERFORMANCE-PERIOD

HCPCS M1026: Patients in Hospice During Performance Period

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

HCPCS M1024: Adolescent Depression Nonremission at Six Months

HCPCS-M1016-FEMALE-INFERTILITY-ASSESSMENT

HCPCS M1016: Female Infertility Assessment and Management

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

HCPCS Level II M1033: Pharmacotherapy Initiation for Opioid Use Disorder

HCPCS-M1014-DISCHARGE-EPISODE-OF-CARE-DOCUMENTATION

HCPCS M1014: Discharge/Discontinuation of Episode of Care

HCPCS-M1040-LUMBAR-IDIOPATHIC-CONGENITAL-SCOLIOSIS

HCPCS M1040: Lumbar Idiopathic or Congenital Scoliosis

HCPCS-M1045-POSTOPERATIVE-KNEE-REPLACEMENT-FUNCTIONAL-STATUS-OKS-KOOS-JR

HCPCS M1045: Postoperative Knee Replacement Functional Outcome Assessment

HCPCS-M1066-SHINGRIX-VACCINE-NOT-DOCUMENTED-ADMINISTERED

HCPCS M1066: Shingrix Vaccine Not Documented as Administered

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Taxonomy Code	Specialty	Notes
`2084P0800X`	Child & Adolescent Psychiatry	Primary specialty managing adolescent depression and outcome measurement.
`208000000X`	Psychiatry & Neurology	Psychiatrists providing medication management and remission assessment.
`2084N0400X`	Pediatric Psychiatry	Psychiatrists with pediatric focus; common for this age group.
`207Q00000X`	Family Medicine	Primary care clinicians who provide follow-up and administer PHQ-9/PHQ-9m.
`367A00000X`	Clinical Social Worker	Licensed mental health clinicians delivering psychotherapy and outcome tracking.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`F32.0`	Major depressive disorder, single episode, mild	Represents adolescents with initial depressive episodes who may achieve remission at six months.
`F32.1`	Major depressive disorder, single episode, moderate	Common baseline severity that is tracked with `PHQ-9` scores to document remission.
`F32.2`	Major depressive disorder, single episode, severe without psychotic features	Higher severity cases managed with medication and psychotherapy and monitored for remission.
`F34.1`	Dysthymic disorder (persistent depressive disorder)	Chronic depressive disorder in adolescents where remission at six months is a meaningful outcome.
`F33.1`	Major depressive disorder, recurrent, moderate	Recurrent depression diagnoses commonly tracked with PHQ-9/PHQ-9m for outcome reporting.

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 billed for administration and scoring of the `PHQ-9` or `PHQ-9m` during the six-month outcome visit when distinct from the clinician visit.
`99402`	Preventive medicine counseling, 30 minutes	May be used for structured counseling delivered during the follow-up visit addressing relapse prevention and wellness planning.
`99406`	Smoking and tobacco use cessation counseling, intermediate, 3–10 minutes	May be used if tobacco counseling is provided as part of comprehensive adolescent behavioral health care.
`99213`	Office or other outpatient visit for established patient, typically 15 minutes	Common E/M code for a routine follow-up visit where the PHQ-9/PHQ-9m is reviewed and remission documented.
`99214`	Office or other outpatient visit for established patient, typically 25 minutes	Used when the six-month assessment requires moderate complexity medical decision-making or extended counseling.
`90834`	Psychotherapy, 45 minutes with patient	Used when psychotherapy is provided during the same visit as the outcome assessment; report per therapy documentation.

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