Diagnostic Codes that will now be accepted for Medicare ...

Diagnostic Codes that will now be accepted for Medicare Part B in 13 States

(Changes to Local Coverage Determination L35101, effective retroactively to December 31, 2015)

Claims for the below diagnostic codes submitted by mental health practitioners participating in the Medicare Part B program in 13 states will no longer be denied. Moreover, claims submitted since December 31, 2015, when the policy was enacted, that have been denied will be retroactively approved and paid. These have been updated to reflect DSM-5, the standard manual used in the U.S. to diagnose mental health conditions.

The affected states are Colorado, New Mexico, Oklahoma, Texas, Arkansas, Louisiana, Mississippi, Delaware, District of Columbia, Maryland, New Jersey, Pennsylvania, and three jurisdictions in Virginia: Arlington and Fairfax Counties, and the City of Alexandria.

Code

Disorder Title in DSM-5

Disorder Title in ICD-10-CM

Alcohol withdrawal, without perceptual

F10.239

Alcohol dependence with withdrawal, unspecified

disturbances

Tobacco Use Disorder, Moderate F17.200

Tobacco Use Disorder, Severe

Nicotine dependence, unspecified, uncomplicated

F20.9

Schizophrenia

Schizophrenia unspecified

F31.9

Bipolar 1 Disorder, Current or most recent episode depressed, unspecified Bipolar 1 Disorder, Current or most recent episode hypomanic, unspecified Bipolar 1 Disorder, Current or most

Bipolar disorder, unspecified

F32.8 F32.9

F33.9 F40.00 F40.10 F41.9 F43.10 F43.20 F43.9 F60.9 F68.10 F80.9

F90.9 F91.9 G25.81 G47.21

G47.22

G47.23

recent episode manic, unspecified Bipolar 1 Disorder, Current or most recent episode, unspecified

Other specified depressive disorder Other depressive episodes

Major Depressive Disorder, single episode, unspecified

Major depressive disorder, single episode, unspecified

Major Depressive Disorder, Recurrent Major depressive disorder, recurrent, unspecified

episode, unspecified

Agoraphobia

Agoraphobia, unspecified

Social Anxiety Disorder (social phobia) Social phobia, unspecified

Unspecified Anxiety Disorder

Anxiety disorder, unspecified

Posttraumatic Stress Disorder

Post-traumatic stress disorder, unspecified

Adjustment Disorder, Unspecified

Adjustment disorder, unspecified

Unspecified Trauma and Stressor Related Disorder

Reaction to severe stress, unspecified

Unspecified Personality Disorder

Personality disorder, unspecified

Factitious Disorder

Factitious disorder, unspecified

Language Disorder

Developmental disorder of speech and language, unspecified

Unspecified attentiondeficit/hyperactivity disorder

Attention-deficit hyperactivity disorder, unspecified type

Conduct disorder, unspecified onset Conduct disorder, unspecified

Restless Legs Syndrome

Restless legs syndrome

Circadian rhythm sleep-wake disorders, Delayed sleep phase type

Circadian rhythm sleep disorder, delayed sleep phase type

Circadian rhythm sleep-wake

Circadian rhythm sleep disorder, advanced sleep

disorders, Advanced sleep phase type phase type

Circadian rhythm sleep-wake disorders, Irregular sleep-wake type

Circadian rhythm sleep disorder, irregular sleep wake type

Circadian rhythm sleep-wake

G47.24

disorders, Non-24-hour sleep-wake type

Circadian rhythm sleep disorder, free running type

G47.26

Circadian rhythm sleep-wake disorders, Shift work type

Circadian rhythm sleep disorder, shift work type

G47.31

Central sleep apnea, Idiopathic central Primary central sleep apnea

sleep apnea

G47.33 Obstructive sleep apnea hypopnea

Obstructive sleep apnea (adult) (pediatric)

G47.34

Sleep-related hypoventilation, Idiopathic hypoventilation

Idiopathic sleep related nonobstructive alveolar hypoventilation

G47.35

Sleep-related hypoventilation, Congenital central alveolar hypoventilation

Congenital central alveolar hypoventilation syndrome

G47.36

Sleep-related hypoventilation, Comorbid sleep-related hypoventilation

Sleep related hypoventilation in conditions classified elsewhere

G47.37

Central sleep apnea comorbid with opioid use

Central sleep apnea in conditions classified elsewhere

Narcolepsy with cataplexy but without

G47.411

Narcolepsy with cataplexy

hypocretin deficiency

G47.419

Autosomal dominant cerebellar ataxia,

deafness, and narcolepsy

Autosomal dominant narcolepsy, obesity, and type 2 diabetes

Narcolepsy without cataplexy

Narcolepsy without cataplexy but with

hypocretin deficiency

L98.1

Excoriation (skin-picking) Disorder

Factitial dermatitis

N94.3 Premenstrual Dysphoric Disorder

Premenstrual tension syndrome

R06.3

Central Sleep Apnea, Cheyne-Stokes Breathing

Periodic breathing

R41.83 Borderline Intellectual Functioning

Borderline intellectual functioning

Antidepressant discontinuation T43.205A

syndrome, Initial encounter

Adverse effect of unspecified antidepressants, initial encounter

T43.205D Antidepressant discontinuation syndrome, Subsequent encounter

Adverse effect of unspecified antidepressants, subsequent encounter

Antidepressant discontinuation T43.205S

syndrome, Sequelae

Adverse effect of unspecified antidepressants, sequela

Other adverse effect of medication, T50.905A

Initial encounter

Adverse effect of unspecified drugs, medicaments and biological substances, initial encounter

Other adverse effect of a medication, Adverse effect of unspecified drugs, medicaments

T50.905D

Subsequent encounter

and biological substances, subsequent encounter

Other adverse effect of a medication, Adverse effect of unspecified drugs, medicaments

T50.905S

Sequelae

and biological substances, sequela

These additions are reflected in Local Coverage Determination (LCD) L35101. The entire LCD can be found at .

To view the full list of psychiatric codes covered, you will first be required to accept the terms and conditions of the website. Once you have accepted the conditions, and the LCD page appears, scroll down to the section titled: ICD-10 Codes that Support Medical Necessity. Next to "show entries", choose "show entries 1-1500."

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