Is Screening for Depression a Payable Medicare Service?

The question often asked is this a payable service or is this a preventative service for Medicare beneficiaries.

The Centers for Medicare & Medicaid Services (CMS) determined that the evidence is adequate to conclude that screening for depression in adults, which is recommended with a grade of B by the U.S. Preventive Services Task Force, is reasonable and necessary for the prevention or early detection of illness or disability and is appropriate for individuals entitled to benefits under Part A or enrolled under Part B.

Therefore, CMS started covering annual screening for depression for Medicare beneficiaries in primary care settings that have staff-assisted depression care supports in place to assure accurate diagnosis, effective treatment and follow-up. However, there has been some confusion in how to report these services, what CPT® or HCPCS code to use, and if time documentation was a factor, and if there were specific tools that had to be used to perform this service.

Eligibility

Medicare Part B covers an annual depression screening. The patient does not need to show signs or symptoms of depression to qualify for screening. However, the screening must take place in a primary care setting, like a doctor’s office. This means Medicare will not cover a depression screening if it takes place in an emergency room, skilled nursing facility, an independent diagnostic testing facility, ambulatory surgery center, inpatient rehabilitation facility, hospice, or inpatient hospital settings.

The annual depression screening includes a questionnaire that the patient completes with the help of their doctor or an advanced practice provider (e.g., physician assistant or nurse practitioner). This questionnaire is designed to indicate if the patient is at risk or has symptoms of depression. More than two years into the pandemic, it is important to find out where your patient is at mentally. If results show that the patient may be at risk of depression, the provider will perform a thorough assessment and will refer may refer the patient for follow-up mental health care if appropriate.

In most cases, depression screenings can take place in addition to an annual well visit, or during a scheduled doctor’s office visit.

Note: A provider is required to review a patient’s potential for depression and other mental health conditions during a Welcome to Medicare Visit and the first annual wellness visit. However, a provider is not required to formally screen for depression during either visit. During a review, the provider should discuss risk factors for depression, such as a family history, but the patient, typically does not receive a screening questionnaire.

Costs

If a patient qualifies for benefits under Part B Medicare, original Medicare covers depression screenings at 100 percent of the Medicare-approved amount when the patient receives the service from a participating provider. This means the patient has no share of cost—no deductible or coinsurance). Medicare Advantage Plans are required to cover depression screenings without applying deductibles, copayments or coinsurance when an in-network provider is seen, and the patient meets Medicare’s eligibility requirements for the service.

During the course of a screening, the provider may discover the need to investigate or treat a new or existing problem. This additional care is considered diagnostic, meaning the provider has moved from screening to treating the patient because of certain symptoms or risk factors. Medicare may bill the patient for any evaluation and management  or for any diagnostic care, added during a preventive visit.

CPT/HCPCS and ICD-10-CM Considerations

Code G0444 may be reported for an annual depression screening up to 15 minutes using any standardized instrument (e.g., PHQ-9) in a primary care setting with clinical staff who can advise the physician of screening results and who can facilitate and coordinate referrals to mental health treatment as necessary.

Per, CMS, at a minimum level, staff-assisted depression care supports consist of clinical staff (e.g., nurse, physician assistant) in the primary care setting who can advise physician of screening results and who can facilitate and coordinate referrals to mental health treatment.

One caveat that was recognized by the American Academy of Family Physicians, was that after CMS implemented code G0444, “some Medicare administrative contractors (MACs) consider the 15 minutes referenced in the descriptor of code G0444 to be a threshold, meaning the physician providing the service must provide a full 15 minutes of depression screening to report the service. Email correspondence with CMS staff at the regional and national level indicate they share this interpretation.”

However, this interpretation is not accurate because the descriptor of code G0444 reads “up to 15 minutes.” As we read the NCD in question, we understand that “up to 15 minutes” is indicative of the brief screening described and that beyond 15 minutes would imply management of depression has been provided in lieu of screening alone.

Although CMS set the time for G0444 at 15 minutes, the crosswalk to code 99211, which has a total physician time of seven minutes and an intra-service time of only five minutes (RVU), indicates CMS viewed the 15 minutes assigned to G0444 not as a threshold but as a maximum beyond which the physician is no longer screening and instead providing additional services (e.g., counseling) reported with other codes.

Effective for claims processed on or after April 2, 2012, Medicare contractors “shall pay for annual depression screening, G0444, no more than once in a 12-month period.”

What is the ICD-10 code for depression screening?

Code Z13. 89, encounter for screening for other disorder, is the ICD-10 code for depression screening.

Programming note: For more on this topic and the role behavioral health can play in your practice, listen to Talk Ten Tuesday today when healthcare consultant and professional coder Terry Fletcher will shed some light on these important and under-utilized services.

References:

https://www.acponline.org/practice-resources/business-resources/office-management/patient-care-office-forms#screenings

https://www.cms.gov/medicare-coverage-database/view/ncacal-decision-memo.aspx?proposed=N&NCAId=251