Products & Programs Federal Employee Program (FEP)CommercialJuly 1, 2024

Antidepressant Medication Management (AMM)

The National Committee Quality Assurance (NCQA) develops and collects HEDIS® measurements to set performance and drive improvement in quality-of-care outcomes.

The Federal Employee Program® (FEP) for Anthem is continuously working to improve clinical quality of care and performance outcomes. To comply with the NCQA standards and improve HEDIS AMM performance rate, FEP takes this opportunity to remind providers to document every service rendered in an accurate, timely manner and use the appropriate ICD-10-CM, CPT®, and HCPCS codes when billing services rendered for patients who are receiving antidepressant medications. Below is a description of the AMM measure, why it is important, exclusions, and helpful tips (such as medical records documentation and best practices).

HEDIS AMM measure description

This HEDIS measure evaluates the percentage of members 18 years of age and older who were treated with antidepressant medication, had a diagnosis of major depression, and who remained on an antidepressant medication treatment. Two rates are reported:

  • Effective acute phase treatment: the percentage of members who remained on antidepressant medication for at least 85 days (12 weeks)
  • Effective continuation phase treatment: the percentage of members who remained on an antidepressant medication for at least 180 days (6 months)

Members with any diagnosis of major depression who are seen in any of the care settings are included in the AMM measure.

Place of services

  • Outpatient visit
  • Telehealth visit
  • ED visit
  • Acute or nonacute inpatient stay
  • Intensive outpatient encounter or partial hospitalization
  • Community mental health center
  • E-Visit or virtual check-in (online assessment)

Why is the HEDIS AMM measure important?

Major depression is a serious mental illness with a significant burden of symptoms and the most common psychiatric disorder in individuals who die from suicide.1 Integrating the right antidepressant medication with appropriate behavioral therapy leads to positive benefits and outcomes for members. Compliance with antidepressant medication is an essential component in treatment guidelines for major depression.2

Exclusions

Enrollees who did not have an encounter with a diagnosis of major depression during the 121-day period from 60 days prior to the index prescription start date (IPSD) through the IPSD and the 60 days after the IPSD

Common behavioral health codes used with any diagnosis of major depression that trigger patients into the HEDIS AMM measure are:

Description

Behavioral health codes (ICD-10-CM, CPT, HCPCS, POS)

Major depression

ICD-10-CM: F32.0–F32.4, F32.9, F33.0–F33.3, F33.41, F33.42, F33.9. F34.1

BH outpatient visit

CPT: 98960–98962, 99078, 99202–99205, 99211–99215, 99242–99245,
99341–99345, 99347–99350, 99381–99387, 99391–99397, 99401–99404, 99411, 99412, 99483, 99492–99494, 99510

HCPCS: G0155, G0176, G0177, G0409, G0463, G0512, H0002, H0004, H0031, H0034, H0036, H0037, H0039, H0040, H2000, H2010, H2011, H2013 - H2020, T1015

Place of service (POS)

POS: 02, 10, 52, 53

Telehealth visit

POS: 10

CPT: 98966–98968, 99441–99443

ED visit

CPT: 99281–99285

E-visit or virtual check-in (online assessment)

CPT: 98970–98972, 98980, 98981, 99421–99423, 99457, 99458

HCPCS: G0071, G2010, G2012, G2250, G2251, G2252

Helpful tips

Medical record documentation:

  • Diagnosis of major depression
  • Date of services
  • Date of dispensing
  • Evidence of antidepressant medication prescription

Best practices:

  • Educate members that most antidepressants take four to six weeks to work.
  • Encourage members to continue any prescribed medication even if they feel better. Inform them of the danger of discontinuing suddenly. If they take the medication for less than six months, they are at a higher risk of recurrence.
  • Assess members within 30 days from when the prescription is first filled for any side effects and their response to treatment.
  • When patients are making a follow-up visit, educate and encourage patients to bring their discharge instructions and medications list to their first appointment.
  • Coordinate care between behavioral health and primary care physicians by sharing progress notes and updates.
  • Educate members on what to do in an emergency, such as when having suicidal thoughts.
  • Focus on member preferences for treatment, allowing the member to take ownership of their health and treatment plan.

  1. https://pubmed.ncbi.nlm.nih.gov/23411024: Accessed January 21, 2020.
  2. https://ncqa.org/hedis/measures/antidepressant-medication-management

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).

Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans, Inc. Independent licensee of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

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PUBLICATIONS: July 2024 Provider Newsletter