2026 # 370 MIPS Measure Depression Remission at Twelve Months

2026 COLLECTION TYPE:

MERIT-BASED INCENTIVE PAYMENT SYSTEM (MIPS) CLINICAL QUALITY MEASURE (CQM)

‌MEASURE TYPE: Outcome– High Priority

Description:

‌The percentage of adolescent patients 12 to 17 years of age and adult patients 18 years of age or older with major depression or dysthymia who reached remission 12 months (+/- 60 days) after an index event date.

Instructions:

Reporting Frequency:
This measure is to be submitted once per performance period for denominator eligible cases as defined in the denominator criteria

Intent and Clinician Applicability:
This measure is intended to reflect the quality of services provided for patients with a diagnosis of depression or dysthymia. This measure may be submitted by Merit-based Incentive Payment System (MIPS) eligible clinicians who perform the quality actions as defined by the numerator based on the services provided and the measure-specific denominator coding.

Measure Strata and Performance Rates:
This measure contains two strata defined by two submission criteria.
This measure produces two performance rates which are used for a weighted average.

There are 2 Submission Criteria for this measure:
1) Adolescent patients with major depression or dysthymia who reached remission at twelve months
Or
2) Adult patients with major depression or dysthymia who reached remission at twelve months

This measure will be calculated with 2 performance rates:
1) Percentage of adolescent patients (aged 12-17 years) with a diagnosis of major depression or dysthymia and an initial PHQ-9 or PHQ-9M score greater than nine during the index event who reached remission at twelve months as demonstrated by a twelve month (+/-60 days) PHQ-9 or PHQ-9M score of less than 5
2) Percentage of adult patients (aged 18 years or older) with a diagnosis of major depression or dysthymia and an initial PHQ-9 or PHQ-9M score greater than nine during the index event who reached remission at twelve months as demonstrated by a twelve month (+/-60 days) PHQ-9 or PHQ-9M score of less than 5

A weighted average, which is the sum of the performance numerator values divided by the sum of performance
denominator values, will be used to calculate performance.

Implementation Considerations:
For the purposes of MIPS implementation, this patient-intermediate measure is submitted a minimum of once per patient during the performance period. The most recent numerator option/quality data code will be used if the measure is submitted more than once.

To be considered denominator eligible for this measure, the patient must have both the diagnosis of depression or dysthymia and a PHQ-9 or PHQ-9M score greater than 9 documented on the same date or up to seven days prior to encounter (index event) and this date occurs during denominator identification period (11/1/2024 to 10/31/2025).

Telehealth:

SUBMISSION CRITERIA 1:
TELEHEALTH ELIGIBLE: This measure is appropriate for and applicable to the telehealth setting. Patient encounters conducted via telehealth using encounter code(s) found in the denominator encounter criteria are allowed for this measure. Therefore, if the patient meets all denominator criteria for a telehealth encounter, it would be appropriate to include them in the denominator eligible patient population. Telehealth eligibility is at the measure level for inclusion within the denominator eligible patient population and based on the measure specification definitions which are independent of changes to coding and/or billing practices.

SUBMISSION CRITERIA 2:
NOT TELEHEALTH ELIGIBLE: This measure submission criteria is not appropriate for nor applicable to the telehealth setting. This measure submission criteria is procedure based and therefore doesn’t allow for the denominator criteria to be conducted via telehealth. It would be appropriate to remove these patients from the denominator eligible patient population. Telehealth eligibility is at the measure submission criteria level for inclusion within the denominator eligible patient population and based on the measure specification definitions which are independent of changes to coding and/or billing practices.

Measure Submission:
The quality data codes listed do not need to be submitted by MIPS eligible clinicians, groups, or third party intermediaries that utilize this collection type for submissions; however, these codes may be submitted for those third party intermediaries that utilize Medicare Part B claims data. The coding provided to identify the measure criteria: Denominator or Numerator, may be an example of coding that could be used to identify patients that meet the intent of this clinical topic. When implementing this measure, please refer to the ‘Reference Coding’ section to determine if other codes or code languages that meet the intent of the criteria may also be used within the medical record to identify and/or assess patients. For more information regarding Application Programming Interface (API), please refer to the Quality Payment Program (QPP) website.

SUBMISSION CRITERIA 1: ADOLESCENT PATIENTS WITH MAJOR DEPRESSION OR DYSTHMIA WHO REACHED REMISSION AT TWELVE MONTHS

Denominator (Criteria 1):

Adolescent patients 12 to 17 years of age with a diagnosis of major depression or dysthymia and an initial PHQ-9 or PHQ9M score greater than nine during the index event.

Definitions:
Denominator Identification Period – The period in which eligible patients can have an index event. The “denominator identification period” occurs prior to the measurement period and is defined as 14 months to two months prior to the start of the measurement period. The “denominator identification period” is from 11/1/2024 to 10/31/2025. For patients with an index event, there needs to be enough time following index for the patients to have the opportunity to reach remission twelve months +/- 60 days after the index event date. Index Event Date – The date on which the first instance of elevated PHQ-9 or PHQ-9M greater than nine AND diagnosis of depression or dysthymia occurs during the denominator identification period (11/1/2024 to 10/31/2025). Patients may be assessed using PHQ-9 or PHQ-9M up to seven days prior to the encounter (including the day of the encounter).
Measure Assessment Period – The index event date marks the start of the measurement assessment period for each patient which is 14 months (12 months +/- 60 days). This assessment period is fixed and does not “start over” with a higher PHQ-9 or PHQ-9M that may occur after the index event date.

DENOMINATOR NOTE:
*Signifies that this CPT Category I code is a non-covered service under the Medicare Part B Physician Fee Schedule (PFS). These non-covered services should be counted in the denominator population for MIPS CQMs.

Denominator Criteria (eligible Cases) 1:
Patients aged ≥ 12 years and ≤ 17 years on date of index event

And

Diagnosis for Major Depression or Dysthymia on date of index event (ICD-10-CM): F32.0, F32.1, F32.2, F32.3, F32.4, F32.5, F32.9, F33.0, F33.1, F33.2, F33.3, F33.40, F33.41, F33.42, F33.9, F34.1

And

Patient encounter during the denominator identification period (CPT or HCPCS): 90791, 90792, 90832, 90834, 90837, 90839, 96156, 96158, 96159, 98000, 98001, 98002, 98003, 98004, 98005, 98006, 98007, 98008, 98009, 98010, 98011, 98012, 98013, 98014, 98015, 98016, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99384*, 99394*, 99421, 99422, 99423, 99441, 99442, 99443, G0402, G0438, G0439

And

Index Event Date PHQ-9 or PHQ-9M Score greater than 9 documented during the twelve month denominator identification period: G9511

And Not

DENOMINATOR EXCLUSIONS:
Patients with an active diagnosis of bipolar disorder any time prior to the end of the measure assessment period: M1447

Or

Patients with an active diagnosis of personality disorder any time prior to the end of the measure assessment period: M1448

Or

Patients with an active diagnosis of schizophrenia or psychotic disorder any time prior to the end of the measure assessment period: M1449

Or

Patients with an active diagnosis of pervasive developmental disorder (e.g., autism spectrum disorder) any time prior to the end of the measure assessment period: M1451

Or

Patients who died any time prior to the end of the measure assessment period: M1446

Or

Patients who received hospice or palliative care service any time during denominator identification period or the measure assessment period: M1450

Reference Coding:

Denominator Exclusion for diagnosis of bipolar disorder [M1447] may be defined by the following coding, however, other codes/code languages that meet the intent of this component may also be used: F30.10, F30.11, F30.12, F30.13, F30.2, F30.3, F30.4, F30.8, F30.9, F31.0, F31.10, F31.11, F31.12, F31.13, F31.2, F31.30, F31.31, F31.32, F31.4, F31.5, F31.60, F31.61, F31.62, F31.63, F31.64, F31.70, F31.71, F31.72, F31.73, F31.74, F31.75, F31.76, F31.77, F31.78, F31.81, F31.89, F31.9

Denominator Exclusion for diagnosis of personality disorder [M1448] may be defined by the following coding, however, other codes/code languages that meet the intent of this component may also be used: F34.0, F60.3, F60.4, F68.10, F68.11, F68.12, F68.13

Denominator Exclusion for diagnosis of schizophrenia or psychotic disorder [M1449] may be defined by the following coding, however, other codes/code languages that meet the intent of this component may also be used: F20.0, F20.1, F20.2, F20.3, F20.5, F20.81, F20.89, F20.9, F21, F23, F25.0, F25.1, F25.8, F25.9, F28, F29

Denominator Exclusion for diagnosis of pervasive developmental disorder [M1451] may be defined by the following coding, however, other codes/code languages that meet the intent of this component may also be used: F84.0, F84.3, F84.8, F84.9

Denominator Exclusion for hospice or palliative care service [M1450] may be defined by the following coding, however, other codes/code languages that meet the intent of this component may also be used: Z51.5

Numerator (Criteria 1):

Adolescent patients aged 12 to 17 years of age who achieved remission at twelve months as demonstrated by a twelve month (+/- 60 days) PHQ-9 or PHQ-9M score of less than five

Definitions:
Remission – a PHQ-9 or PHQ-9M score of less than five.
Twelve Months – Is defined as the point in time from the index event date extending out “twelve months” and then allowing a grace period of sixty days prior to and sixty days after this date. The most recent PHQ-9 or PHQ-9M score less than five obtained during this four month period is deemed as remission at “twelve months”, values obtained prior to or after this period are not counted as numerator compliant (remission).

Numerator Options:

Performance Met: Adolescent patients 12 to 17 years of age with major depression or dysthymia who reached remission at twelve months as demonstrated by a twelve month (+/-60 days) PHQ-9 or PHQ-9M score of less than 5 (M1019)

Or

Performance Not Met: Adolescent patients 12 to 17 years of age with major depression or dysthymia who did not reach remission at twelve months as demonstrated by a twelve month (+/-60 days) PHQ-9 or PHQ-9M score of less than 5. Either PHQ-9 or PHQ-9M score was not assessed or is greater than or equal to 5 (M1020)

Or

SUBMISSION CRITERIA 2: ADULT PATIENTS WITH MAJOR DEPRESSION OR DYSTHMIA WHO REACHED REMISSION AT TWELVE MONTHS

Denominator (Criteria 2):

Adult patients aged 18 and older with a diagnosis of major depression or dysthymia and an initial PHQ-9 or PHQ-9M score greater than nine during the index event.

Definitions:
Denominator Identification Period – The period in which eligible patients can have an index event. The “denominator identification period” occurs prior to the measurement period and is defined as 14 months to two months prior to the start of the measurement period. The “denominator identification period” is from 11/1/2024 to 10/31/2025. For patients with an index event, there needs to be enough time following index for the patients to have the opportunity to reach remission 12 months +/- 60 days after the index event date. Index Event Date – The date on which the first instance of elevated PHQ-9 or PHQ-9M greater than 9 AND diagnosis of depression or dysthymia occurs during the denominator identification period (11/1/2024 to 10/31/2025). Patients may be assessed using PHQ-9 or PHQ-9M up to 7 days prior to the encounter (including the day of the encounter).
Measure Assessment Period – The index event date marks the start of the “measurement assessment period” for each patient which is 14 months (12 months +/- 60 days). This assessment period is fixed and does not “start over” with a higher PHQ-9 or PHQ-9M that may occur after the index event date.

DENOMINATOR NOTE:
*Signifies that this CPT Category I code is a non-covered service under the Medicare Part B Physician Fee Schedule (PFS). These non-covered services should be counted in the denominator population for MIPS CQMs.

Denominator Criteria (Eligible Cases) :

Patients aged ≥ 18 years on date of index event

And

Diagnosis for Major Depression or Dysthymia on date of index event (ICD-10-CM): F32.0, F32.1, F32.2, F32.3,
F32.4, F32.5, F32.9, F33.0, F33.1, F33.2, F33.3, F33.40, F33.41, F33.42, F33.9, F34.1

And

Patient encounter during the denominator identification period (CPT or HCPCS): 90791, 90792, 90832, 90834, 90837, 90839, 96156, 96158, 96159, 98000, 98001, 98002, 98003, 98004, 98005, 98006, 98007, 98008, 98009, 98010, 98011, 98012, 98013, 98014, 98015, 98016, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99385*, 99386*, 99387*, 99395*, 99396*, 99397*, 99421, 99422, 99423, 99441, 99442, 99443, G0402, G0438, G0439

And

Index Event Date PHQ-9 or PHQ-9M Score greater than 9 documented during the twelve month denominator identification period: G9511

And Not

DENOMINATOR EXCLUSIONS:
Patients with an active diagnosis of bipolar disorder any time prior to the end of the measure assessment period: M1447

Or

Patients with an active diagnosis of personality disorder any time prior to the end of the measure assessment period: M1448

Or

Patients with an active diagnosis of schizophrenia or psychotic disorder any time prior to the end of the measure assessment period: M1449

Or

Patients with an active diagnosis of pervasive developmental disorder (e.g., autism spectrum disorder) any time prior to the end of the measure assessment period: M1451

Or

Patients who died any time prior to the end of the measure assessment period: M1446

Or

Patients who received hospice or palliative care service any time during denominator identification period or the measure assessment period: M1450

Reference Coding:

Denominator Exclusion for diagnosis of bipolar disorder [M1447] may be defined by the following coding, however, other codes/code languages that meet the intent of this component may also be used: F30.10, F30.11, F30.12, F30.13, F30.2, F30.3, F30.4, F30.8, F30.9, F31.0, F31.10, F31.11, F31.12, F31.13, F31.2, F31.30, F31.31, F31.32, F31.4, F31.5, F31.60, F31.61, F31.62, F31.63, F31.64, F31.70, F31.71, F31.72, F31.73, F31.74, F31.75, F31.76, F31.77, F31.78, F31.81, F31.89, F31.9

Denominator Exclusion for diagnosis of personality disorder [M1448] may be defined by the following coding, however, other codes/code languages that meet the intent of this component may also be used: F34.0, F60.3, F60.4, F68.10, F68.11, F68.12, F68.13

Denominator Exclusion for diagnosis of schizophrenia or psychotic disorder [M1449] may be defined by the following coding, however, other codes/code languages that meet the intent of this component may also be used: F20.0, F20.1, F20.2, F20.3, F20.5, F20.81, F20.89, F20.9, F21, F23, F25.0, F25.1, F25.8, F25.9, F28, F29

Denominator Exclusion for diagnosis of pervasive developmental disorder [M1451] may be defined by the following coding, however, other codes/code languages that meet the intent of this component may also be used: F84.0, F84.3, F84.8, F84.9

Denominator Exclusion for hospice or palliative care service [M1450] may be defined by the following coding, however, other codes/code languages that meet the intent of this component may also be used: Z51.5

Numerator (Criteria 2):

Adult patients aged 18 years of age and older who achieved remission at twelve months as demonstrated by a twelve month (+/- 60 days) PHQ-9 or PHQ-9M score of less than five.

Definitions:
Remission – a PHQ-9 or PHQ-9M score of less than five.
Twelve Months – If defined as the point in time from the index event date extending out “twelve months” and then allowing a grace period of sixty days prior to and sixty days after this date. The most recent PHQ-9 or PHQ-9M score less than five obtained during this four month period is deemed as remission at twelve months, values obtained prior to or after this period are not counted as numerator compliant (remission).

Numerator Options:

Performance Met: PAdult patients 18 years of age or older with major depression or dysthymia who reached remission at twelve months as demonstrated by a twelve month (+/-60 days) PHQ-9 or PHQ9M score of less than 5 (G9509)

Or

Performance Met: Pain severity quantified; no pain present (1126F)

Or

Performance Not Met: Adult patients 18 years of age or older with major depression or dysthymia who did not reach remission at twelve months as demonstrated by a twelve month (+/-60 days) PHQ-9 or PHQ9M score of less than 5. Either PHQ- 9 or PHQ-9M score was not assessed or is greater than or equal to 5 (G9510

Rationale:

Adults:
Depression is a common and treatable mental disorder. During 2013-2016, 8.1% of American adults age 20 and over had depression in a given 2 week period. Women (10.4%) were almost twice as likely as were men (5.5%) to have had depression. The prevalence of depression among adults decreased as family income levels increase. About 80% of adults with depression reported at least some difficulty with work, home, or social activities because of their depression symptoms (Brody, Pratt and Hughes, 2018).
Depression is a risk factor for development of chronic illnesses such as diabetes and CHD and adversely affects the course, complications and management of chronic medical illness. Both maladaptive health risk behaviors and psychobiological factors associated with depression may explain depression’s negative effect on outcomes of chronic illness (Katon, 2011).
Adolescents and Adults:
The Centers for Disease Control and Prevention states that during 2009-2012 an estimated 7.6% of the U.S. population aged 12 and over had depression, including 3% of Americans with severe depressive symptoms. Almost 43% of persons with severe depressive symptoms reported serious difficulties in work, home and social activities, yet only 35% reported having contact with a mental health professional in the past year (Pratt and Brody, 2014).
Depression is associated with higher mortality rates in all age groups. Depression is also a leading cause of medical disability and depressed people lose 5.6 hours of productive work every week when they are depressed, 50% of which is due to absenteeism and short-term disability (Stewart et al., 2003).
Adolescents:
In 2014, an estimated 2.8 million adolescents age 12 to 17 in the United States had at least one major depressive episode (MDE) in the past year (Center for Behavioral Health Statistics and Quality, 2015). The 2013 Youth Risk Behavior Survey of students grades 9 to 12 indicated that during the past 12 months 39.1% of female (F) and 20.8% of male (M) students indicated feeling sad or hopeless almost every day for at least 2 weeks,16.9% (F) and 10.3% (M) indicated a planned suicide attempt, and 10.6% (F) and 5.4% (M) attempted suicide (Kann etr al., 2014). Adolescent-onset depression is associated with chronic depression in adulthood. Many mental health conditions (anxiety, bipolar, depression, eating disorders, and substance abuse) are evident by age 14. The 12-month prevalence of MDEs increased from 8.7% in 2005 to 11.3% in 2014 in adolescents and from 8.8% to 9.6% in young adults (both P < .001). The increase was larger and
statistically significant only in the age range of 12 to 20 years. The trends remained significant after adjustment for substance use disorders and sociodemographic factors (Mojtabai, Olfson, and Han 2016). Mental health care contacts overall did not change over time; however, the use of specialty mental health providers increased in adolescents and young adults, and the use of prescription medications and inpatient hospitalizations increased in adolescents.