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CMS128v6 Code List

Code List: CMS128v6, Anti-depressant Medication Management

MicroMD uses the following code lists to determine a patient’s inclusion in this measure.  To search for your code, simply press Ctrl + F on your keyboard, enter your code in the search field and press Enter on your keyboard.

This user-friendly code list is provided as a courtesy to our MicroMD users.  For more in-depth information about codes and/or criteria or to compare version changes, visit the CMS eCQI Resource Center at https://ecqi.healthit.gov/ (no user account required) or the United States Health Information Knowledgebase at https://ushik.ahrq.gov/mdr/portals (requires a free user account to view codes).

Item Codes
Diagnosis Codes
Diagnosis: Major Depression: ICD-10 F32.0, F32.1, F32.2, F32.3, F32.4, F32.9, F33.0, F33.1, F33.2, F33.3, F33.41, F33.9
Diagnosis: Major Depression: SNOMED 14183003, 15193003, 15639000, 18818009, 191601008, 191602001, 191604000, 191610000, 191611001, 191613003, 20250007, 231499006, 251000119105, 25922000, 2618002, 268620009, 268621008, 274948002, 281000119103, 28475009, 300706003, 30605009, 319768000, 320751009, 321717001, 33078009, 33135002, 33736005, 36474008, 36923009, 370143000, 38694004, 39809009, 40379007, 42925002, 430852001, 450714000, 60099002, 63778009, 66344007, 69392006, 70747007, 71336009, 719592004, 720451004, 720452006, 720453001, 720454007, 720455008, 73867007, 75084000, 76441001, 77911002, 79298009, 832007, 87512008
Encounter Codes
Encounter, Performed: Annual Wellness Visit: HCPCS G0438, G0439
Encounter, Performed: Face-to-Face Interaction: SNOMED 12843005, 18170008, 185349003, 185463005, 185465003, 19681004, 207195004, 270427003, 270430005, 308335008, 390906007, 406547006, 439708006, 87790002, 90526000
Encounter, Performed: Home Healthcare Services: CPT 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350
Encounter, Performed: Office Visit: CPT 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215
Encounter, Performed: Preventive Care Services – Established Office Visit, 18 and Up: CPT 99395, 99396, 99397
Encounter, Performed: Preventive Care Services-Initial Office Visit, 18 and Up: CPT 99385, 99386, 99387
Encounter, Performed: Psych Visit – Diagnostic Evaluation: CPT 90791, 90792
Encounter, Performed: Psych Visit – Psychotherapy: CPT 90832, 90834, 90837
Medications
Medication: Antidepressant Medication: Description (RXNORM code) {2 (24 HR levomilnacipran 20 MG Extended Release Oral Capsule) / 26 (24 HR levomilnacipran 40 MG Extended Release Oral Capsule) } Pack (1433249); {7 (vilazodone hydrochloride 10 MG Oral Tablet) / 23 (vilazodone hydrochloride 20 MG Oral Tablet) } Pack (1653469); {7 (vilazodone hydrochloride 10 MG Oral Tablet) / 7 (vilazodone hydrochloride 20 MG Oral Tablet) / 16 (vilazodone hydrochloride 40 MG Oral Tablet) } Pack (1086789); 12 HR Bupropion Hydrochloride 100 MG Extended Release Oral Tablet (993503); 12 HR Bupropion Hydrochloride 150 MG Extended Release Oral Tablet (993518); 12 HR Bupropion Hydrochloride 200 MG Extended Release Oral Tablet (993536); 24 HR Bupropion hydrobromide 174 MG Extended Release Oral Tablet (993550); 24 HR Bupropion hydrobromide 348 MG Extended Release Oral Tablet (993567); 24 HR Bupropion hydrobromide 522 MG Extended Release Oral Tablet (993681); 24 HR Bupropion Hydrochloride 150 MG Extended Release Oral Tablet (993541); 24 HR Bupropion Hydrochloride 300 MG Extended Release Oral Tablet (993557); 24 HR Bupropion Hydrochloride 450 MG Extended Release Oral Tablet (1232585); 24 HR Desvenlafaxine 100 MG Extended Release Oral Tablet (790264); 24 HR Desvenlafaxine 50 MG Extended Release Oral Tablet (790288); 24 HR desvenlafaxine succinate 25 MG Extended Release Oral Tablet (1607617); 24 HR Fluvoxamine Maleate 100 MG Extended Release Oral Capsule (903873); 24 HR Fluvoxamine Maleate 150 MG Extended Release Oral Capsule (903879); 24 HR levomilnacipran 120 MG Extended Release Oral Capsule (1433217); 24 HR levomilnacipran 20 MG Extended Release Oral Capsule (1433227); 24 HR levomilnacipran 40 MG Extended Release Oral Capsule (1433233); 24 HR levomilnacipran 80 MG Extended Release Oral Capsule (1433239); 24 HR Paroxetine Hydrochloride 12.5 MG Extended Release Oral Tablet (1738803); 24 HR Paroxetine Hydrochloride 25 MG Extended Release Oral Tablet (1738805); 24 HR Paroxetine Hydrochloride 37.5 MG Extended Release Oral Tablet (1738807); 24 HR Selegiline 0.25 MG/HR Transdermal System (865206); 24 HR Selegiline 0.375 MG/HR Transdermal System (865210); 24 HR Selegiline 0.5 MG/HR Transdermal System (865214); 24 HR Trazodone Hydrochloride 150 MG Extended Release Oral Tablet (898697); 24 HR Trazodone Hydrochloride 300 MG Extended Release Oral Tablet (898704); 24 HR venlafaxine 150 MG Extended Release Oral Capsule (313581); 24 HR venlafaxine 150 MG Extended Release Oral Tablet (808744); 24 HR venlafaxine 225 MG Extended Release Oral Tablet (808748); 24 HR venlafaxine 37.5 MG Extended Release Oral Capsule (313583); 24 HR venlafaxine 37.5 MG Extended Release Oral Tablet (808751); 24 HR venlafaxine 75 MG Extended Release Oral Capsule (313585); 24 HR venlafaxine 75 MG Extended Release Oral Tablet (808753); Amitriptyline Hydrochloride 10 MG / Perphenazine 2 MG Oral Tablet (856706); Amitriptyline Hydrochloride 10 MG / Perphenazine 4 MG Oral Tablet (856720); Amitriptyline Hydrochloride 10 MG Oral Tablet (856783); Amitriptyline Hydrochloride 100 MG Oral Tablet (856762); Amitriptyline Hydrochloride 12.5 MG / Chlordiazepoxide 5 MG Oral Tablet (856769); Amitriptyline Hydrochloride 150 MG Oral Tablet (856773); Amitriptyline Hydrochloride 25 MG / Chlordiazepoxide 10 MG Oral Tablet (856792); Amitriptyline Hydrochloride 25 MG / Perphenazine 2 MG Oral Tablet (856797); Amitriptyline Hydrochloride 25 MG / Perphenazine 4 MG Oral Tablet (856825); Amitriptyline Hydrochloride 25 MG Oral Tablet (856834); Amitriptyline Hydrochloride 50 MG / Perphenazine 4 MG Oral Tablet (856840); Amitriptyline Hydrochloride 50 MG Oral Tablet (856845); Amitriptyline Hydrochloride 75 MG Oral Tablet (856853); Amoxapine 100 MG Oral Tablet (197363); Amoxapine 150 MG Oral Tablet (197364); Amoxapine 25 MG Oral Tablet (197365); Amoxapine 50 MG Oral Tablet (197366); Bupropion Hydrochloride 100 MG Oral Tablet (993687); Bupropion Hydrochloride 75 MG Oral Tablet (993691); Citalopram 10 MG Oral Capsule (730440); Citalopram 10 MG Oral Tablet (283672); Citalopram 2 MG/ML Oral Solution (309313); Citalopram 20 MG Oral Capsule (730441); Citalopram 20 MG Oral Tablet (200371); Citalopram 40 MG Oral Capsule (730442); Citalopram 40 MG Oral Tablet (309314); Clomipramine Hydrochloride 25 MG Oral Capsule (857297); Clomipramine Hydrochloride 25 MG Oral Tablet (857296); Clomipramine Hydrochloride 50 MG Oral Capsule (857301); Clomipramine Hydrochloride 50 MG Oral Tablet (857315); Clomipramine Hydrochloride 75 MG Oral Capsule (857305); Desipramine Hydrochloride 10 MG Oral Tablet (1099288); Desipramine Hydrochloride 100 MG Oral Tablet (1099292); Desipramine Hydrochloride 150 MG Oral Tablet (1099296); Desipramine Hydrochloride 25 MG Oral Tablet (1099300); Desipramine Hydrochloride 50 MG Oral Tablet (1099304); Desipramine Hydrochloride 75 MG Oral Tablet (1099316); Doxepin Hydrochloride 10 MG Oral Capsule (1000048); Doxepin Hydrochloride 10 MG/ML Oral Solution (1000054); Doxepin Hydrochloride 100 MG Oral Capsule (1000058); Doxepin Hydrochloride 150 MG Oral Capsule (1000064); Doxepin Hydrochloride 25 MG Oral Capsule (1000070); Doxepin Hydrochloride 50 MG Oral Capsule (1000076); Doxepin Hydrochloride 75 MG Oral Capsule (1000097); duloxetine 20 MG Delayed Release Oral Capsule (596926); duloxetine 30 MG Delayed Release Oral Capsule (596930); duloxetine 40 MG Delayed Release Oral Capsule (616402); duloxetine 60 MG Delayed Release Oral Capsule (596934); Escitalopram 1 MG/ML Oral Solution (351285); Escitalopram 10 MG Oral Tablet (349332); Escitalopram 20 MG Oral Tablet (351250); Escitalopram 5 MG Oral Tablet (351249); Fluoxetine 10 MG Oral Capsule (310384); Fluoxetine 10 MG Oral Tablet (313990); Fluoxetine 20 MG Oral Capsule (310385); Fluoxetine 20 MG Oral Tablet (248642); Fluoxetine 25 MG / olanzapine 12 MG Oral Capsule (403970); Fluoxetine 25 MG / olanzapine 3 MG Oral Capsule (721787); Fluoxetine 25 MG / olanzapine 6 MG Oral Capsule (403969); Fluoxetine 4 MG/ML Oral Solution (310386); Fluoxetine 40 MG Oral Capsule (313989); Fluoxetine 50 MG / olanzapine 12 MG Oral Capsule (403971); Fluoxetine 50 MG / olanzapine 6 MG Oral Capsule (403972); Fluoxetine 60 MG Oral Tablet (1190110); Fluoxetine 90 MG Delayed Release Oral Capsule (313995); Fluvoxamine Maleate 100 MG Oral Tablet (903884); Fluvoxamine Maleate 25 MG Oral Tablet (903887); Fluvoxamine Maleate 50 MG Oral Tablet (903891); Imipramine Hydrochloride 10 MG Oral Tablet (835593); Imipramine Hydrochloride 25 MG Oral Tablet (835564); Imipramine Hydrochloride 50 MG Oral Tablet (835568); Imipramine pamoate 100 MG Oral Capsule (835591); Imipramine pamoate 125 MG Oral Capsule (835589); Imipramine pamoate 150 MG Oral Capsule (835577); Imipramine pamoate 75 MG Oral Capsule (835572); Isocarboxazid 10 MG Oral Tablet (104837); Maprotiline Hydrochloride 25 MG Oral Tablet (1298857); Maprotiline Hydrochloride 50 MG Oral Tablet (1298861); Maprotiline Hydrochloride 75 MG Oral Tablet (1298870); Mirtazapine 15 MG Disintegrating Oral Tablet (283406); Mirtazapine 15 MG Oral Tablet (311725); Mirtazapine 30 MG Disintegrating Oral Tablet (283407); Mirtazapine 30 MG Oral Tablet (314111); Mirtazapine 45 MG Disintegrating Oral Tablet (283485); Mirtazapine 45 MG Oral Tablet (311726); Mirtazapine 7.5 MG Oral Tablet (476809); Nefazodone hydrochloride 100 MG Oral Tablet (1098649); Nefazodone hydrochloride 150 MG Oral Tablet (1098666); Nefazodone hydrochloride 200 MG Oral Tablet (1098670); Nefazodone hydrochloride 250 MG Oral Tablet (1098674); Nefazodone hydrochloride 50 MG Oral Tablet (1098678); Nortriptyline 10 MG Oral Capsule (198045); Nortriptyline 10 MG Oral Tablet (199283); Nortriptyline 2 MG/ML Oral Solution (312036); Nortriptyline 25 MG Oral Capsule (317136); Nortriptyline 50 MG Oral Capsule (198046); Nortriptyline 75 MG Oral Capsule (198047); Paroxetine Hydrochloride 10 MG Oral Tablet (1738483); Paroxetine Hydrochloride 2 MG/ML Oral Suspension (312242); Paroxetine Hydrochloride 20 MG Oral Tablet (1738495); Paroxetine Hydrochloride 30 MG Oral Tablet (1738503); Paroxetine Hydrochloride 40 MG Oral Tablet (1738511); Paroxetine mesylate 10 MG Oral Tablet (1738515); Paroxetine mesylate 20 MG Oral Tablet (1738519); Paroxetine mesylate 30 MG Oral Tablet (1738523); Paroxetine mesylate 40 MG Oral Tablet (1738527); Paroxetine mesylate 7.5 MG Oral Capsule (1430122); Phenelzine 15 MG Oral Tablet (312347); Protriptyline Hydrochloride 10 MG Oral Tablet (905168); Protriptyline Hydrochloride 5 MG Oral Tablet (905172); selegiline hydrochloride 1.25 MG Disintegrating Oral Tablet (859190); selegiline hydrochloride 5 MG Oral Capsule (859186); selegiline hydrochloride 5 MG Oral Tablet (859193); Sertraline 100 MG Oral Tablet (312938); Sertraline 20 MG/ML Oral Solution (861064); Sertraline 25 MG Oral Tablet (312940); Sertraline 50 MG Oral Tablet (312941); Smoking Cessation 12 HR Bupropion Hydrochloride 150 MG Extended Release Oral Tablet (1801289); Tranylcypromine 10 MG Oral Tablet (313447); Trazodone Hydrochloride 100 MG Oral Tablet (856373); Trazodone Hydrochloride 150 MG Oral Tablet (856364); Trazodone Hydrochloride 300 MG Oral Tablet (856369); Trazodone Hydrochloride 50 MG Oral Tablet (856377); Trimipramine 100 MG Oral Capsule (313496); Trimipramine 100 MG Oral Tablet (313497); Trimipramine 25 MG Oral Capsule (313498); Trimipramine 25 MG Oral Tablet (199820); Trimipramine 50 MG Oral Capsule (313499); Trimipramine 50 MG Oral Tablet (245373); venlafaxine 100 MG Oral Tablet (313580); venlafaxine 25 MG Oral Tablet (313582); venlafaxine 37.5 MG Oral Tablet (313584); venlafaxine 50 MG Oral Tablet (314277); venlafaxine 75 MG Oral Tablet (313586); vilazodone hydrochloride 10 MG Oral Tablet (1086772); vilazodone hydrochloride 20 MG Oral Tablet (1086778); vilazodone hydrochloride 40 MG Oral Tablet (1086784); vortioxetine 10 MG Oral Tablet (1439808); vortioxetine 15 MG Oral Tablet (1439840); vortioxetine 20 MG Oral Tablet (1439810); vortioxetine 5 MG Oral Tablet (1439812)
Hospice Exclusion Codes
Encounter, Performed: Encounter Inpatient 183452005, 32485007, 8715000
Intervention, Order: Hospice Care 385763009, 385765002
Discharge Codes to Health Care Facility for Hospice Care 428371000124100
Discharge Codes to Home for Hospice Care 428361000124107

Last updated: June 11, 2018 at 2:01 pm