Summary & Overview

HCPCS M1024: Adolescent Depression Nonremission at Six Months

HCPCS Level II code M1024 identifies adolescent patients (ages 12–17) 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 5 or higher, or when the six-month assessment was not completed. Nationally, this code signals persistent depressive symptoms in adolescents and is used to track ongoing severity and need for continued or adjusted treatment. It is relevant for quality measurement, care coordination, and longitudinal outcome monitoring in pediatric behavioral health programs.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical context for the code, typical service settings, and the primary purposes for use: documenting nonremission, supporting follow-up care pathways, and enabling performance measurement. The publication outlines available benchmarks and reporting considerations where data is present and notes when input fields are unavailable.

The report provides operational details for clinicians and billing teams, clarifies where this code fits in adolescent depression care workflows, and summarizes the documentation elements tied to a six-month PHQ-9 or PHQ-9M assessment. Data not available in the input is identified explicitly in relevant sections.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareM1024HCPCS Level IIadolescent depressionPHQ-9behavioral healthcare managementquality measurementoutpatient mental healthpediatric psychiatry

Billing Code Overview

HCPCS Level II code M1024 identifies adolescent patients aged 12 to 17 years with major depression or dysthymia who have not reached remission at six months. The code applies when a six-month (+/- 60 days) PHQ-9 or PHQ-9M assessment shows a score of greater than or equal to 5, or when a six-month PHQ-9 or PHQ-9M score was not assessed. This reflects ongoing depressive symptoms or a lack of documented remission after an acute treatment period.

Service Type: Depression severity assessment and care monitoring for adolescents

Typical Site of Service: Outpatient behavioral health clinics, pediatric or adolescent psychiatry clinics, primary care clinics providing behavioral health follow-up, and community mental health centers

Clinical & Coding Specifications

Clinical Context

An adolescent aged 12–17 with a documented diagnosis of major depressive disorder or persistent depressive disorder (dysthymia) enters a six-month follow-up evaluation after initiation of psychotherapy, pharmacotherapy, or combined treatment. The clinic schedules a standardized symptom assessment using the Patient Health Questionnaire for Adolescents (PHQ-9 or PHQ-9m) within the six-month window (±60 days). If the standardized score is not <5 (remission threshold) or if no PHQ-9/PHQ-9m was completed, the patient meets the criteria described by billing code M1024 for documentation of non-remission at six months.

A typical workflow:

At treatment initiation the clinician documents baseline diagnosis, treatment plan, and schedules follow-up assessments.
At approximately six months, front-desk or nursing staff administers the PHQ-9 or PHQ-9m in-person or via secure patient portal; results are entered into the electronic health record.
The treating clinician reviews the PHQ-9/PHQ-9m score, documents that remission (score <5) was not achieved, and records clinical decision-making (e.g., treatment adjustment, referral, safety plan) in the progress note.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when additional work or complexity beyond typical visit complexity is documented during the visit (e.g., extensive coordination or complex decision-making).
`23`	Unusual anesthesia	Not typically applicable to behavioral health; included for completeness when sedation/anesthesia is unexpectedly required.
`52`	Reduced services	Use when the full service was not provided as originally intended (e.g., abbreviated assessment).
`53`	Discontinued procedure	Use if the assessment or visit was started but discontinued due to patient factors (e.g., emergent transfer).
`54`	Surgical care only	Not applicable to this behavioral health code; included for limited scenarios with procedural overlap.
`55`	Postoperative management only	Not applicable in routine behavioral health follow-up.
`56`	Preoperative management only	Not applicable to this code.
`62`	Two surgeons	Rarely applicable; included for multidisciplinary visits where two distinct clinicians bill separately and documentation supports co-management.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery	Not applicable to this assessment code.
`CO`	Items or services paid under workers' compensation	Use when the visit is billed to a workers' compensation payer.
`CQ`	Telehealth originating site facility fee paid by Medicare	Use when billing for an originating site facility fee under applicable payor rules.
`FX`	Separate diagnosis or service unrelated to the primary	Use when a separate unrelated service is furnished and requires distinct reporting.
`FY`	Diagnostic service performed by a non-physician practitioner	Use when a non-physician clinician performs the diagnostic assessment and payer requires this modifier.
`QK`	Medical direction of two, three, or four concurrent anesthesia procedures	Not typically applicable; included for multidisciplinary procedural settings.
`QX`	Services furnished by a CRNA under an anesthesia care team	Not applicable to behavioral health assessments.

Taxonomy Code	Specialty	Notes
`207Q00000X`	Psychiatry & Neurology (Psychiatry)	Psychiatrists commonly manage adolescent depression and medication management.
`2084P0800X`	Pediatrics (Pediatrician)	Pediatricians in primary care often perform screening and follow-up assessments.
`363L00000X`	Psychology	Psychologists perform diagnostic assessment and measurement-based care with `PHQ-9` instruments.
`367A00000X`	Family Medicine	Family medicine physicians provide ongoing management and follow-up in community settings.
`176P00000X`	Mental Health Counselor	Licensed clinical social workers or counselors deliver psychotherapy and routine outcome measurement.

ICD-10 Code	Description	Clinical Relevance
`F32.0`	Mild depressive episode	Represents a level of depressive severity evaluated with `PHQ-9` at six months.
`F32.1`	Moderate depressive episode	Common diagnosis among adolescents who may not reach remission at six months.
`F32.2`	Severe depressive episode without psychotic symptoms	Relevant for cases requiring intensified treatment when `PHQ-9` remains ≥5.
`F33.0`	Major depressive disorder, recurrent, mild	Used for recurrent presentations monitored with serial `PHQ-9` assessments.
`F33.1`	Major depressive disorder, recurrent, moderate	Commonly associated with ongoing treatment and measurement-based follow-up.
`F34.1`	Dysthymia (persistent depressive disorder)	Chronic depressive disorder targeted by longitudinal outcome measurement like the `PHQ-9m`.
`Z65.8`	Other problems related to psychosocial circumstances	Often documented as contributing factors requiring psychosocial interventions when remission is not achieved.

CPT Code	Description	Relationship to This Procedure
`96127`	Brief emotional/behavioral assessment with scoring and documentation (e.g., depression inventory), per standardized instrument	Commonly used for administration and scoring of brief measures like the `PHQ-9` in follow-up visits; supports measurement-based care documentation alongside `M1024`.
`90791`	Psychiatric diagnostic evaluation (no medical services)	Often used at treatment initiation for diagnostic assessment prior to the six-month measurement period.
`90834`	Psychotherapy, 45 minutes with patient	Provides ongoing psychotherapy that may occur between initiation and six-month follow-up; documents therapeutic care supporting measurement outcomes.
`99407`	Intensive counseling for tobacco use (greater than 10 minutes)	Example of a behavioral counseling CPT that may be provided in the same encounter when comorbid behavioral risks are addressed; included as a commonly billed behavioral intervention code.
`99492`	Initial psychiatric collaborative care management, first 70 minutes (per month)	Relevant where collaborative care models are used for adolescent depression; supports care management activities over the treatment period.

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