Patient Health Questionnaire-9 (PHQ-9) 

The PHQ-9 is a 9-item, self-report screening tool that scores depressive symptom severity from 0–27 based on the past two weeks, using established bands (minimal, mild, moderate, moderately severe, severe). It takes about 5 minutes to complete and is commonly used to screen for and monitor depression, including as a mood comorbidity check in post-concussion and TBI care.

What the PHQ-9 Measures

The PHQ-9 maps directly to the nine DSM criteria for major depressive disorder: anhedonia, depressed mood, sleep disturbance, fatigue, appetite change, guilt/worthlessness, concentration difficulty, psychomotor changes, and thoughts of death or self-harm. Each item is rated 0 ("not at all") to 3 ("nearly every day") over the prior two weeks, producing a single severity score that is easy to trend over time. Because it was designed for both screening and monitoring, the same instrument that flags a new case of depression can also be re-administered at follow-up visits to track treatment response — which is what makes it useful as a between-visit monitoring tool, not just an intake form.

In concussion and TBI-adjacent care, the PHQ-9 is typically deployed as a comorbidity screen rather than a primary diagnostic instrument: mood symptoms are common after brain injury, can be mistaken for or can compound post-concussive symptoms, and are worth tracking independently of symptom scales like the PCSS. Kroenke et al. (2001) established the instrument in primary care populations, and its structure and validation are documented in the peer-reviewed literature and in CMS/AAPC billing guidance (opens in a new tab) referenced below.

Administration Time

Most patients complete the PHQ-9 in about 5 minutes, whether on paper or self-administered digitally. It requires no clinician time to administer when delivered as a standalone patient-facing screen, though a clinician must review the total score and, critically, Item 9 (thoughts of self-harm) before the encounter concludes or the result is filed.

Scoring and Interpretation

The PHQ-9 total score ranges from 0 to 27 and is generally interpreted using these established bands:

These bands are well-standardized in the clinical literature and can be used with reasonable confidence, unlike some of the newer or less-validated instruments in a typical concussion battery. One item requires special handling regardless of the total score: Item 9 asks about thoughts of being better off dead or of self-harm. Any positive response on Item 9 warrants direct clinical follow-up at the time of scoring — it should never be treated as just one point contributing to a composite total. Practices using the PHQ-9 for remote or between-visit monitoring should have a defined escalation pathway for a positive Item 9 response before deploying the instrument outside the clinic.

Clinical Use Case

The PHQ-9 is used two ways in specialty practices that see concussion, TBI, or chronic headache patients: as an intake screen to identify patients who need a mood-focused referral or intervention, and as a serial monitoring tool to track whether depressive symptoms are resolving, persisting, or worsening across a recovery timeline. It pairs naturally with the GAD-7 for anxiety and the PCL-5 for trauma-related symptoms, since mood, anxiety, and trauma symptoms frequently co-occur after injury. For guidance on when a positive screen should trigger a broader workup, see Screening for Depression After TBI.

Billing: Which CPT Code Covers the PHQ-9

This page provides general educational information about CPT and RTM billing codes. It is not coding advice, a guarantee of reimbursement, or a substitute for your own compliance review. Payer coverage and documentation requirements vary by plan and can change — verify current requirements with CMS, your Medicare Administrative Contractor, and each payer before billing.

When billed as a standalone standardized instrument — separate from a full neuropsychological battery — the PHQ-9 is generally captured under CPT 96127 (brief emotional/behavioral assessment with a standardized instrument, including scoring and documentation). In many encounters it is instead bundled into the E/M visit itself rather than billed separately. When the PHQ-9 is administered as one component of a larger technician- or clinician-administered neurocognitive battery, its administration time may instead roll into the broader test-administration codes (such as 96138/96139) with interpretation captured under 96132/96133. Which path applies depends on how the instrument is delivered, who reviews it, and payer-specific policy — confirm current requirements before submitting claims. For a broader look at coding brief standardized screens, see Documenting Medical Necessity for Neuropsych Testing.

Where the PHQ-9 Sits in the Kavera Protocol

Within Kavera's assessment battery, the PHQ-9 is one of the mood/anxiety screens delivered as part of the Mental Health module and is commonly deployed alongside the Concussion module battery for patients with suspected mood comorbidity. It is administered on the same recurring cadence as the platform's other patient-facing instruments, generating the trend data used for both clinical decision-making and RTM/billing documentation.

How Kavera Handles This

The PHQ-9 is administered at the first visit and repeats between visits in the Mental Health module. Kavera scores it, bands it, and flags any positive Item 9 for same-day review. For NP-led mental health practices it runs as a standalone program with the guided support tool; for concussion practices it runs beside PCSS. Administration supports 96127 and the between-visit record supports RTM. Self-Serve practices run this with their own staff. On Managed, Juliet Mott's team runs it and bills it under your credentials.

FAQ

What does a PHQ-9 score of 10 or higher mean?

A score of 10–14 falls in the "moderate" band and is a widely used general cutoff suggesting further clinical evaluation for depression may be warranted. It is a screening indicator, not a standalone diagnosis — clinical judgment and, where appropriate, a structured interview should confirm any diagnosis.

Does a positive Item 9 always mean a suicide risk assessment is needed?

Any positive response to Item 9 (thoughts of self-harm or being better off dead) warrants direct, timely clinical follow-up regardless of the total score. Practices deploying the PHQ-9 remotely should have a defined protocol for reviewing and escalating positive Item 9 responses promptly.

Can the PHQ-9 be billed on the same day as an E/M visit?

In many cases the PHQ-9 is bundled into the E/M encounter rather than billed as a separate line item. Whether separate billing under 96127 is appropriate depends on documentation, payer policy, and how the instrument was administered — verify with the specific payer before billing.

How often should the PHQ-9 be re-administered?

There is no single universal interval; many protocols re-administer at regular follow-up intervals or as part of ongoing remote monitoring to track symptom trajectory over a recovery or treatment course. The appropriate cadence depends on clinical context and monitoring goals.

Is the PHQ-9 diagnostic on its own?

No. The PHQ-9 is a validated screening and severity-tracking tool, not a substitute for a full clinical diagnostic interview. A positive screen supports — but does not replace — clinical evaluation.

Sources

• Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001. (opens in a new tab)
• CMS — Billing and Coding: Psychological and Neuropsychological Testing (A57481) (opens in a new tab)
• APA Services — 2026 Psychological and Neuropsychological Testing: Billing/Coding (opens in a new tab)