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CMS128v5 Code List

Code List: CMS128v5, 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.

ItemCodes
Diagnosis Codes
Diagnosis: Major Depression: ICD-9296.20, 296.21, 296.22, 296.23, 296.24, 296.25, 296.30, 296.31, 296.32, 296.33, 296.34, 296.35
Diagnosis: Major Depression: ICD-10F32.0, 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: SNOMED832007, 2618002, 14183003, 15193003, 15639000, 18818009, 20250007, 25922000, 28475009, 30605009, 33078009, 33135002, 33736005, 36474008, 36923009, 38694004, 39809009, 40379007, 42925002, 60099002, 63778009, 66344007, 69392006, 70747007, 71336009, 73867007, 75084000, 76441001, 77911002, 79298009, 87512008, 191601008, 191602001, 191604000, 191610000, 191611001, 191613003, 231499006, 268620009, 268621008, 274948002, 300706003, 319768000, 320751009, 321717001, 370143000, 430852001, 450714000, 251000119105, 281000119103
Encounter Codes
Encounter, Performed: Annual Wellness Visit: HCPCSG0438, G0439
Encounter, Performed: Face-to-Face Interaction: SNOMED12843005, 18170008, 185349003, 185463005, 185465003, 19681004, 207195004, 270427003, 270430005, 308335008, 390906007, 406547006, 439708006, 87790002, 90526000
Encounter, Performed: Home Healthcare Services: CPT99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350
Encounter, Performed: Office Visit: CPT99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215
Encounter, Performed: Preventive Care Services – Established Office Visit, 18 and Up: CPT99395, 99396, 99397
Encounter, Performed: Preventive Care Services-Initial Office Visit, 18 and Up: CPT99385, 99386, 99387
Encounter, Performed: Psych Visit – Diagnostic Evaluation: CPT90791, 90792
Encounter, Performed: Psych Visit – Psychotherapy: CPT90832, 90834, 90837
Medications
Medication, Active: Antidepressant Medication: Descriptions (RXNORM)Doxepin Hydrochloride 10 MG Oral Capsule, Doxepin Hydrochloride 10 MG/ML Oral Solution, Doxepin Hydrochloride 100 MG Oral Capsule, Doxepin Hydrochloride 150 MG Oral Capsule, Doxepin Hydrochloride 25 MG Oral Capsule, Doxepin Hydrochloride 50 MG Oral Capsule, Doxepin Hydrochloride 75 MG Oral Capsule, Isocarboxazid 10 MG Oral Tablet, vilazodone hydrochloride 10 MG Oral Tablet, vilazodone hydrochloride 20 MG Oral Tablet, vilazodone hydrochloride 40 MG Oral Tablet, {7 (vilazodone hydrochloride 10 MG Oral Tablet) / 7 (vilazodone hydrochloride 20 MG Oral Tablet) / 16 (vilazodone hydrochloride 40 MG Oral Tablet) } Pack, Nefazodone hydrochloride 100 MG Oral Tablet, Nefazodone hydrochloride 150 MG Oral Tablet, Nefazodone hydrochloride 200 MG Oral Tablet, Nefazodone hydrochloride 250 MG Oral Tablet, Nefazodone hydrochloride 50 MG Oral Tablet, Nefazodone hydrochloride 300 MG Oral Tablet, Desipramine Hydrochloride 10 MG Oral Tablet, Desipramine Hydrochloride 100 MG Oral Tablet, Desipramine Hydrochloride 150 MG Oral Tablet, Desipramine Hydrochloride 25 MG Oral Tablet, Desipramine Hydrochloride 50 MG Oral Tablet, Desipramine Hydrochloride 75 MG Oral Tablet, Fluoxetine 60 MG Oral Tablet, 24 HR Bupropion Hydrochloride 450 MG Extended Release Tablet, Maprotiline Hydrochloride 25 MG Oral Tablet, Maprotiline Hydrochloride 50 MG Oral Tablet, Maprotiline Hydrochloride 75 MG Oral Tablet, Amoxapine 100 MG Oral Tablet, Amoxapine 150 MG Oral Tablet, Amoxapine 25 MG Oral Tablet, Amoxapine 50 MG Oral Tablet, Nortriptyline 10 MG Oral Capsule, Nortriptyline 50 MG Oral Capsule, Nortriptyline 75 MG Oral Capsule, Nortriptyline 10 MG Oral Tablet, Trimipramine 25 MG Oral Tablet, Citalopram 20 MG Oral Tablet, Trimipramine 50 MG Oral Tablet, Fluoxetine 20 MG Oral Tablet, Sertraline 200 MG Oral Tablet, Mirtazapine 15 MG Disintegrating Tablet, Mirtazapine 30 MG Disintegrating Tablet, Mirtazapine 45 MG Disintegrating Tablet, Citalopram 10 MG Oral Tablet, Citalopram 2 MG/ML Oral Solution, Citalopram 40 MG Oral Tablet, Desipramine 25 MG Oral Capsule, Desipramine 50 MG Oral Capsule, Fluoxetine 10 MG Oral Capsule, Fluoxetine 20 MG Oral Capsule, Fluoxetine 4 MG/ML Oral Solution, Mirtazapine 15 MG Oral Tablet, Mirtazapine 45 MG Oral Tablet, Nortriptyline 2 MG/ML Oral Solution, Paroxetine 10 MG Oral Tablet, Paroxetine 2 MG/ML Oral Suspension, Paroxetine 30 MG Oral Tablet, Paroxetine 40 MG Oral Tablet, Phenelzine 15 MG Oral Tablet, Sertraline 100 MG Oral Tablet, Sertraline 25 MG Oral Tablet, Sertraline 50 MG Oral Tablet, Tranylcypromine 10 MG Oral Tablet, Trimipramine 100 MG Oral Capsule, Trimipramine 100 MG Oral Tablet, Trimipramine 25 MG Oral Capsule, Trimipramine 50 MG Oral Capsule, venlafaxine 100 MG Oral Tablet, 24 HR venlafaxine 150 MG Extended Release Capsule, venlafaxine 25 MG Oral Tablet, 24 HR venlafaxine 37.5 MG Extended Release Capsule, venlafaxine 37.5 MG Oral Tablet, 24 HR venlafaxine 75 MG Extended Release Capsule, venlafaxine 75 MG Oral Tablet, Fluoxetine 40 MG Oral Capsule, Fluoxetine 10 MG Oral Tablet, Fluoxetine 90 MG Enteric Coated Capsule, Mirtazapine 30 MG Oral Tablet, Paroxetine 20 MG Oral Tablet, venlafaxine 50 MG Oral Tablet, Nortriptyline 25 MG Oral Capsule, Escitalopram 10 MG Oral Tablet, Escitalopram 5 MG Oral Tablet, Escitalopram 20 MG Oral Tablet, Escitalopram 1 MG/ML Oral Solution, Fluoxetine 25 MG / olanzapine 6 MG Oral Capsule, Fluoxetine 25 MG / olanzapine 12 MG Oral Capsule, Fluoxetine 50 MG / olanzapine 12 MG Oral Capsule, Fluoxetine 50 MG / olanzapine 6 MG Oral Capsule, Mirtazapine 7.5 MG Oral Tablet, Paroxetine 12.5 MG Extended Release Tablet, Paroxetine 25 MG Extended Release Tablet, Paroxetine 37.5 MG Extended Release Tablet, duloxetine 20 MG Enteric Coated Capsule, duloxetine 30 MG Enteric Coated Capsule, duloxetine 60 MG Enteric Coated Capsule, Fluoxetine 25 MG / olanzapine 3 MG Oral Capsule, Citalopram 10 MG Oral Capsule, Citalopram 20 MG Oral Capsule, Citalopram 40 MG Oral Capsule, 24 HR Desvenlafaxine 100 MG Extended Release Tablet, 24 HR Desvenlafaxine 50 MG Extended Release Tablet, Sertraline 150 MG Oral Tablet, Fluoxetine 15 MG Oral Tablet, 24 HR venlafaxine 150 MG Extended Release Tablet, 24 HR venlafaxine 225 MG Extended Release Tablet, 24 HR venlafaxine 37.5 MG Extended Release Tablet, 24 HR venlafaxine 75 MG Extended Release Tablet, Imipramine Hydrochloride 25 MG Oral Tablet, Imipramine Hydrochloride 50 MG Oral Tablet, Imipramine pamoate 75 MG Oral Capsule, Imipramine pamoate 150 MG Oral Capsule, Imipramine Hydrochloride 12.5 MG/ML Injectable Solution, Imipramine pamoate 125 MG Oral Capsule, Imipramine pamoate 100 MG Oral Capsule, Imipramine Hydrochloride 10 MG Oral Tablet, Trazodone Hydrochloride 150 MG Oral Tablet, Trazodone Hydrochloride 300 MG Oral Tablet, Trazodone Hydrochloride 100 MG Oral Tablet, Trazodone Hydrochloride 50 MG Oral Tablet, Amitriptyline Hydrochloride 10 MG / Perphenazine 2 MG Oral Tablet, Amitriptyline Hydrochloride 10 MG / Perphenazine 4 MG Oral Tablet, Amitriptyline Hydrochloride 100 MG Oral Tablet, Amitriptyline Hydrochloride 12.5 MG / Chlordiazepoxide 5 MG Oral Tablet, Amitriptyline Hydrochloride 150 MG Oral Tablet, Amitriptyline Hydrochloride 10 MG Oral Tablet, Amitriptyline Hydrochloride 25 MG / Chlordiazepoxide 10 MG Oral Tablet, Amitriptyline Hydrochloride 25 MG / Perphenazine 2 MG Oral Tablet, Amitriptyline Hydrochloride 25 MG / Perphenazine 4 MG Oral Tablet, Amitriptyline Hydrochloride 25 MG Oral Tablet, Amitriptyline Hydrochloride 50 MG / Perphenazine 4 MG Oral Tablet, Amitriptyline Hydrochloride 50 MG Oral Tablet, Amitriptyline Hydrochloride 75 MG Oral Tablet, Clomipramine Hydrochloride 10 MG Oral Tablet, Clomipramine Hydrochloride 25 MG Oral Tablet, Clomipramine Hydrochloride 25 MG Oral Capsule, Clomipramine Hydrochloride 50 MG Oral Capsule, Clomipramine Hydrochloride 75 MG Oral Capsule, Clomipramine Hydrochloride 50 MG Oral Tablet, Sertraline 20 MG/ML Oral Solution, 24 HR selegiline hydrochloride 0.25 MG/HR Transdermal Patch, 24 HR selegiline hydrochloride 0.375 MG/HR Transdermal Patch, 24 HR selegiline hydrochloride 0.5 MG/HR Transdermal Patch, 24 HR Trazodone Hydrochloride 150 MG Extended Release Tablet, 24 HR Trazodone Hydrochloride 300 MG Extended Release Tablet, 24 HR Fluvoxamine Maleate 100 MG Extended Release Capsule, 24 HR Fluvoxamine Maleate 150 MG Extended Release Capsule, Fluvoxamine Maleate 100 MG Oral Tablet, Fluvoxamine Maleate 25 MG Oral Tablet, Fluvoxamine Maleate 50 MG Oral Tablet, Protriptyline Hydrochloride 10 MG Oral Tablet, Protriptyline Hydrochloride 5 MG Oral Tablet, Doxepin 3 MG Oral Tablet, Doxepin 6 MG Oral Tablet, 12 HR Bupropion Hydrochloride 100 MG Extended Release Tablet, 12 HR Bupropion Hydrochloride 150 MG Extended Release Tablet, 12 HR Bupropion Hydrochloride 200 MG Extended Release Tablet, 24 HR Bupropion Hydrochloride 150 MG Extended Release Tablet, 24 HR Bupropion hydrobromide 174 MG Extended Release Tablet, 24 HR Bupropion Hydrochloride 300 MG Extended Release Tablet, 24 HR Bupropion hydrobromide 348 MG Extended Release Tablet, 24 HR Bupropion hydrobromide 522 MG Extended Release Tablet, Bupropion Hydrochloride 100 MG Oral Tablet, Bupropion Hydrochloride 75 MG Oral Tablet