CMS Pub. 100-03, ch. 1, § 210.9

A. General

Among persons older than 65 years, one in six suffers from depression. Depression in older adults is

estimated to occur in 25% of those with other illness including cancer, arthritis, stroke, chronic lung disease,

and cardiovascular disease. Other stressful events, such as the loss of friends and loved ones, are also risk

factors for depression. Opportunities are missed to improve health outcomes when mental illness is under-recognized and under-treated in primary care settings.

Older adults have the highest risk of suicide of all age groups. These patients are important in the primary

care setting because 50-75% of older adults who commit suicide saw their medical doctor during the prior

month for general medical care, and 39% were seen during the week prior to their death. Symptoms of major

depression that are felt nearly every day include, but are limited to, feeling sad or empty; less interest in

daily activities; weight loss or gain when not dieting; less ability to think or concentrate; tearfulness, feelings

of worthlessness, and thoughts of death or suicide.

Based upon authority to cover “additional preventive services” for Medicare beneficiaries if certain statutory

requirements are met, the Centers for Medicare & Medicaid Services (CMS) initiated a new national

coverage analysis on screening for depression in adults. Screening for depression in adults is recommended

with a grade of B by the U.S. Preventive Services Task Force (USPSTF) and is appropriate for individuals

entitled to benefits under Part A and Part B.

Therefore, effective October 14, 2011, CMS will cover annual screening for depression for Medicare

beneficiaries in primary care settings that have staff-assisted depression care supports in place to assure

accurate diagnosis, effective treatment, and follow-up. Various screening tools are available for screening

for depression. CMS does not identify specific depression screening tools. Rather, the decision to use a

specific tool is at the discretion of the clinician in the primary care setting.

Coverage is limited to screening services and does not include treatment options for depression or any

diseases, complications, or chronic conditions resulting from depression, nor does it address therapeutic

interventions such as pharmacotherapy, combination therapy (counseling and medications), or other

interventions for depression.

B. Nationally Covered Indications

Effective for claims with dates of service on or after October 14, 2011, CMS will cover annual screening up

to 15 minutes for Medicare beneficiaries when staff-assisted depression care supports are in place to assure

accurate diagnosis, effective treatment, and follow-up. At a minimum level, staff-assisted supports consist

of clinical staff (e.g., nurse, physician assistant) in the primary care setting who can advise the physician of

screening results and who can facilitate and coordinate referrals to mental health treatment.

C. Nationally Non-Covered Indications

Screening for depression is non-covered when performed more than one time in a 12-month period. In

addition, self-help materials, telephone calls, and web-based counseling are not separately reimbursable by

Medicare and are not part of this NCD.

D. Other

Medicare coinsurance and Part B deductible are waived for this preventive service

(This NCD last reviewed October 2011.)