Depression Screening for Adolescents and Adults Tip Sheet

Incentives will be paid on an annual basis, following the end of Quarter 4. For additional information refer to the CBI Technical Specifications.

Members will be excluded from the measure if they have a history bipolar disorder any time during the member’s history through the end of the year prior to the measurement period.

Members with depression that starts during the year prior to the measurement period.

Members in hospice or using hospice services any time during the measurement period.

Members who died during the measurement year.

To view applicable diagnosis codes for the exclusion, see the CBI Technical Specifications.

Medical records must document:

• The name of the depression screening tool and result. If the screening is positive, follow-up should occur on or up to 30 days after the first positive screen.

Documented follow-up can include:

• An outpatient, telephone, e-visit or virtual check-in follow-up visit with a diagnosis of depression or other behavioral health condition.
• A depression case management encounter that documents assessment for symptoms of depression or a diagnosis of depression or other behavioral health condition.
• A behavioral health encounter, including assessment, therapy, collaborative care or medication management.
• A dispensed antidepressant medication OR
• Documentation of additional depression screening on a full-length instrument indicating either no depression or no symptoms that require follow-up (i.e., a negative screen) on the same day as a positive screen on a brief screening instrument.

Screening is only reimbursable with a validated screening tool. Screening tools do not need to be sent to the Alliance and must be maintained in the patient’s medical record. Example tools include:

The measure uses non-billable LOINC codes, which need a corresponding result in order for the screening to count in the measure.

Data for this measure will be collected using Data Submission Tool. To find gaps in data:

• Run a report from your Electronic Health Record (EHR) system.
• Manually compile patient data (Example: Download the CBI report on the Provider Portal and compare to EHR).

Note: For CBI 2023, the depression measure is captured through claims and DST using different codes. CBI 2024 will only receive codes through the DST.

• Complete screening annually in addition to clinical judgment, consideration of risk factors, comorbid conditions, and member life events (e.g. pregnancy).
• For those with a history of depression, screen at each visit.
• Medical Assistant administers initial depression screen and documents results.
• Screen patients at least once during the perinatal period for depression and anxiety symptoms.
• Screen for postpartum depression at the infant’s one, two, four, and six-month well-child visits and beyond.
• Utilize collaborative care interventions involving multifaceted care team approaches (e.g. primary care physician, case manager with mental health background, psychiatrist, etc.).
• Implement a call back program for reaching out to patients with positive screens to keep engagement.
• Refer Alliance members to Care Management services, including Complex Case Management and Care Coordination, by calling Case Management at 800-700-3874, ext. 5512.
• Refer Alliance members to Enhanced Care Management (ECM) Services and Community Supports through the Alliance Provider Portal, email ([email protected]), mail or fax, or by phone at 831-430-5512.
• Alliance interpreting services are available to network providers:
  • Telephonic interpreting services are available to assist in scheduling members.
  • Face-to-face interpreters can be requested to be at the appointment with the member.

  For information about our Cultural and Linguistic Services Program, please call the Alliance Health Education Line at 800-700-3874, ext. 5580 or email us at [email protected].

• Refer patients who have transportation challenges to the Alliance’s Transportation Coordinator at 800-700-3874, ext. 5577. This service is not covered for non-medical locations or for appointments that are not medically necessary.

• Alliance Behavioral Health website
• Carelon Primary Care Provider (PCP) Referral Form
• Carelon Care Management Referral Form