PHQ-9 scoring: score ranges and documentation

In this article▾

1. PHQ-9 scoring at a glance
2. How to calculate a PHQ-9 score
3. What does each PHQ-9 score mean?
4. Item 9: The PHQ-9 question clinicians should not overlook
5. PHQ-9 is not a diagnosis by itself
6. PHQ-9 and functional impairment
7. How to document the PHQ-9 in a clinical note
8. Using the PHQ-9 to monitor treatment progress
9. PHQ-9 and CPT 96127
10. Common PHQ-9 documentation mistakes
11. PHQ-9 scoring quick reference
12. Frequently asked questions about the PHQ-9
13. Final takeaway
14. Sources

The PHQ-9 is a nine-item self-report questionnaire used to assess the severity of depressive symptoms. Each item is scored from 0 to 3, producing a total score from 0 to 27. Higher scores indicate greater depressive symptom severity. The PHQ-9 is commonly used for screening, baseline assessment, and monitoring symptom change over time.

For clinicians, knowing how to calculate the score is only the first step. The result also needs to be interpreted in clinical context, item 9 needs separate attention, and the assessment needs to be documented if it is being used as part of clinical care or reported with a code such as CPT 96127.

PHQ-9 scoring at a glance

Each of the nine PHQ-9 items is rated according to how often the patient has experienced the symptom during the previous two weeks:

Add the scores for all nine items.

Maximum score: 27

PHQ-9 score interpretation

The cut points of 5, 10, 15 and 20 come from the instrument's original validation study. They describe symptom severity, not a diagnosis.

The PHQ-9 is free to use without permission, which is part of why it is the most widely deployed depression measure in U.S. primary care.

How to calculate a PHQ-9 score

Scoring is straightforward:

1. Review the patient's response to each of the nine items.
2. Convert each response to its corresponding point value: 0, 1, 2, or 3.
3. Add the nine item scores.
4. Record the total score.
5. Interpret the total using the severity range.
6. Review item 9 separately.
7. Interpret the result alongside the patient's clinical presentation and functional impairment.

Example

Suppose a patient's nine item scores are:

2 + 2 + 1 + 2 + 1 + 2 + 1 + 2 + 0 = 13

The patient's total PHQ-9 score is 13, which falls in the moderate range.

The documentation should not stop at "PHQ-9 = 13." The clinician should also document the clinical meaning of the result, relevant functional impact, and any follow-up assessment prompted by the responses.

What does each PHQ-9 score mean?

PHQ-9 score 0-4: None/minimal

A score from 0 to 4 indicates few or minimal depressive symptoms on the questionnaire.

This does not mean that the patient has no mental health concerns. A clinician may still identify depression, another psychiatric condition, grief, substance-related symptoms, or other concerns that require assessment.

The score should be interpreted in the context of the reason the PHQ-9 was administered.

PHQ-9 score 5-9: Mild

A score from 5 to 9 falls in the mild range.

Depending on the clinical context, the result may support monitoring, further assessment, behavioral interventions, or other appropriate follow-up. The score alone does not determine whether treatment is indicated.

PHQ-9 score 10-14: Moderate

A score from 10 to 14 falls in the moderate range.

A score of 10 or greater is the usual threshold for further clinical evaluation, and that is where the instrument's best-known figure comes from. In Kroenke, Spitzer and Williams' 2001 validation study, a PHQ-9 score of 10 or above, measured against a structured mental health professional interview, had a sensitivity of 88% and a specificity of 88% for major depression. The same study is where the 5, 10, 15 and 20 cut points come from.

Two caveats worth carrying. Those figures come from one study population of primary care and obstetrics-gynecology patients, and they describe how well the score sorts people, not whether any individual patient has the disorder.

Sources: Kroenke, Spitzer and Williams (2001), Journal of General Internal Medicine

The clinician should evaluate the patient's symptoms against the applicable diagnostic criteria rather than diagnosing depression from the score alone.

PHQ-9 score 15-19: Moderately severe

A score from 15 to 19 indicates moderately severe depressive symptoms.

The result warrants clinical attention and should be interpreted alongside the patient's functional impairment, risk factors, comorbidities, and treatment history.

PHQ-9 score 20-27: Severe

A score from 20 to 27 falls in the severe range.

This indicates a high level of reported depressive symptoms and warrants clinical evaluation. The score does not establish the appropriate level of care or determine whether a patient needs hospitalization, partial hospitalization or another service; behavioral health payers generally work that out through the ASAM levels of care or an equivalent framework.

Those decisions require a broader clinical assessment.

Item 9: The PHQ-9 question clinicians should not overlook

Item 9 asks about thoughts that the patient would be better off dead or of hurting themselves.

The item is scored in the same way as the other PHQ-9 items, but it should not be treated as simply another number in the total score.

A positive response to item 9 requires further assessment of suicide risk by someone qualified to conduct that assessment. The PHQ-9 item is a screening question and does not establish the presence, severity, or immediacy of suicide risk on its own.

AHRQ is explicit that relying on item 9 alone to screen for suicide risk is insufficient, because it does not ask about current plans or intent. A patient can score 3 on item 9 and have no plan, and a patient can score 0 and be at serious risk.

Sources: AHRQ Integration Academy: screening and diagnosis

How to document a positive item 9

Do not document only:

"PHQ-9 = 17."

If item 9 is positive, document the follow-up assessment and clinical disposition according to your organization's suicide-risk protocol.

For example:

"PHQ-9 total score 17, moderately severe range. Item 9 endorsed at [score]. Suicide risk assessment completed. Patient [denies/reports] current suicidal intent, plan, or access to means. Protective factors and risk factors reviewed. Safety plan [completed/reviewed] and follow-up arranged."

The exact documentation should reflect what was actually assessed. Do not copy a template statement that does not match the encounter.

PHQ-9 is not a diagnosis by itself

One of the most important interpretation rules is that a PHQ-9 score is not the same thing as a diagnosis of major depressive disorder.

The instrument measures depressive symptoms and can support screening, assessment, and monitoring. A diagnostic determination requires clinical evaluation.

For example, two patients could both have a PHQ-9 score of 14 while having substantially different clinical presentations.

One patient might have a depressive disorder with significant functional impairment. Another might have symptoms related to a medical condition, medication, substance use, bereavement, another psychiatric condition, or a transient situational problem.

The score provides useful structured information. It does not replace clinical judgment. For the diagnostic framework behind the symptom domains the PHQ-9 is measuring, see our SIGECAPS guide, which also flags the one symptom the mnemonic leaves out.

PHQ-9 and functional impairment

The PHQ-9 includes a separate question asking how difficult the reported problems have made it to work, take care of things at home, or get along with other people.

That response should be documented rather than ignored.

For example:

PHQ-9: 13, moderate range. Functional impairment: somewhat difficult.

This communicates more than the total score alone.

For treatment planning and medical-necessity documentation, the clinician should describe the actual functional effects when clinically relevant.

For example:

"Patient reports depressed mood, anhedonia, sleep disturbance, and low energy. PHQ-9 score is 13. Symptoms are making it very difficult to maintain concentration at work and complete routine household responsibilities."

The PHQ-9 score supports the symptom assessment. The narrative explains how those symptoms affect the individual patient.

For more on documentation, see our medical necessity glossary entry. If a patient's presentation includes periods of elevated or irritable mood, the DIGFAST guide covers the manic-episode domains that would change the formulation.

How to document the PHQ-9 in a clinical note

A useful PHQ-9 entry should make the instrument, score, interpretation, and clinical response clear.

At minimum, consider documenting:

• Instrument: PHQ-9
• Date administered
• Total score
• Severity range
• Functional impairment
• Item 9 response
• Follow-up risk assessment, when indicated
• Clinical interpretation
• Treatment or follow-up plan

Simple PHQ-9 documentation example

PHQ-9 administered today. Total score: 11, moderate range. Patient reports symptoms have made functioning somewhat difficult. Item 9 = 0. Results reviewed with patient and incorporated into treatment planning. Will continue to monitor depressive symptoms and repeat assessment as clinically indicated.

Documentation example with a positive item 9

PHQ-9 administered today. Total score: 18, moderately severe range. Item 9 = 1. Suicide risk assessment completed following endorsement. Current suicidal intent and plan assessed and documented separately. Risk and protective factors reviewed. Safety plan and follow-up recommendations documented. PHQ-9 results incorporated into treatment planning.

Again, the second example should only be used as a structure. The actual note needs to reflect the clinician's assessment.

Using the PHQ-9 to monitor treatment progress

The PHQ-9 can also be useful for tracking changes in depressive symptoms over time.

A clinician might document:

PHQ-9 decreased from 18 at baseline to 11 today. Patient reports improved sleep and increased participation in daily activities but continues to experience anhedonia and low energy. Continue current treatment plan and reassess symptoms at follow-up.

This is more clinically useful than documenting a score without context.

When tracking scores, consider documenting:

• Baseline score
• Current score
• Change in score
• Relevant symptom changes
• Functional changes
• Treatment changes
• Clinical interpretation

A lower score can indicate improvement in depressive symptoms, but the change should still be interpreted in the context of the patient's overall presentation.

PHQ-9 and CPT 96127

PHQ-9 administration and scoring may be reported using CPT 96127, which describes a brief emotional or behavioral assessment using a standardized instrument, with scoring and documentation, per standardized instrument. CMS lists 96127 among the codes for developmental and behavioral screening and testing, and AAPC specifically identifies the PHQ-9 as an example of an instrument that can be reported with 96127.

The important documentation point is simple: do not let the claim say more than the note supports.

If a practice reports 96127, the record should show that the standardized assessment was performed, scored and documented. Payer policies can impose additional requirements, so verify the applicable rules, and bear in mind that an assessment billed without a documented score is the kind of gap that surfaces later as a CO-16 rejection rather than a clinical dispute.

On the coding side, see our psychotherapy CPT codes guide for how brief assessments sit alongside the session codes, and charge capture for getting them onto the claim in the first place.

Common PHQ-9 documentation mistakes

1. Documenting only the total score

"PHQ-9 = 15" provides limited clinical context.

Add the severity interpretation, functional impact, and relevant clinical response.

2. Treating the score as the diagnosis

A score of 12 does not automatically mean the patient has major depressive disorder.

Document the clinical assessment separately.

3. Ignoring item 9

A positive item 9 requires appropriate suicide-risk follow-up. It should not be dismissed because the total score is low.

4. Failing to document functional impairment

The score describes symptom severity. The note should explain how symptoms affect the patient's functioning when that information is relevant to treatment.

5. Copying forward an old score

Always identify the date of the assessment. If a current score is being compared with a prior score, document both.

6. Billing without documenting the assessment

If 96127 is reported, the record should support the standardized assessment, scoring, and documentation. Payer requirements should also be checked before assuming that every PHQ-9 automatically results in a separately payable service.

PHQ-9 scoring quick reference

These ranges are commonly used PHQ-9 severity categories. They should support, not replace, clinical assessment.

Frequently asked questions about the PHQ-9

What is the maximum PHQ-9 score?

The maximum PHQ-9 score is 27. Each of the nine items is scored from 0 to 3.

What is a normal PHQ-9 score?

A score of 0-4 falls in the none/minimal range. However, a low score does not by itself rule out all mental health concerns or eliminate the need for clinical assessment.

What does a PHQ-9 score of 10 mean?

A score of 10 is at the lower boundary of the moderate range. It is also a commonly used threshold for further evaluation of depressive symptoms. It does not, by itself, establish a diagnosis of major depressive disorder.

What does a PHQ-9 score of 20 mean?

A score of 20 falls in the severe range. The result indicates substantial reported depressive symptoms and warrants clinical evaluation. The score alone does not determine the appropriate treatment setting.

Does PHQ-9 diagnose depression?

The PHQ-9 can support depression screening and assessment, but a score should not be used as a standalone diagnosis. Clinical evaluation is required.

What does PHQ-9 item 9 measure?

Item 9 asks about thoughts of being better off dead or thoughts of hurting oneself. A positive response requires appropriate suicide-risk assessment. The item should not be used as a standalone suicide-risk assessment.

Where do the PHQ-9 severity ranges come from?

From the instrument's 2001 validation study by Kroenke, Spitzer and Williams, which reported that scores of 5, 10, 15 and 20 represented mild, moderate, moderately severe and severe depression. The same paper is the source of the widely quoted 88% sensitivity and 88% specificity at a cutoff of 10 or above.

How many items does the PHQ-9 have, and what does it map to?

Nine, each scored 0 to 3 over the previous two weeks. The items correspond to the DSM depressive symptom criteria, which is why the instrument reads like a structured version of a symptom review rather than a general mood scale.

Is the PHQ-9 free to use?

Yes. It can be used without permission, which is a large part of why it became the default depression measure in U.S. primary care.

Can PHQ-9 be billed with CPT 96127?

PHQ-9 is an example of a standardized instrument that may be reported with CPT 96127 when the service meets the code and applicable payer requirements. The assessment needs to be scored and documented, and payer-specific coverage and billing rules should be verified.

Final takeaway

The PHQ-9 is simple to score but should not be reduced to a single number.

A complete clinical use of the instrument involves:

1. Administering the nine items for the specified two-week period.
2. Adding the item scores to produce a 0-27 total.
3. Interpreting the total using the established severity ranges.
4. Reviewing item 9 separately and conducting additional suicide-risk assessment when indicated.
5. Considering functional impairment and the broader clinical presentation.
6. Documenting the score, interpretation, and clinical response.
7. Supporting the assessment documentation when CPT 96127 is reported.

Used this way, the PHQ-9 provides a consistent way to assess depressive symptoms at baseline and monitor change without replacing the clinician's diagnostic assessment.

Sources

1. Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606-613. pubmed.ncbi.nlm.nih.gov
2. American Psychological Association. Patient Health Questionnaire. apa.org
3. American Psychological Association. Depression assessment instruments. apa.org
4. National HIV Curriculum, University of Washington. Patient Health Questionnaire-9 (PHQ-9). hiv.uw.edu
5. AHRQ Integration Academy. Screening and diagnosis. integrationacademy.ahrq.gov
6. American Academy of Professional Coders. CPT code 96127. aapc.com

Related guides: SIGECAPS · DIGFAST · OLDCARTS · Psychotherapy CPT codes · Medical necessity

Every source above was opened and checked on October 4, 2026. This is educational content and does not replace the published instrument, your organization's protocol, or clinical judgment.