LCD Reference Article Billing and Coding Article

Billing and Coding: Psychiatric Diagnostic Evaluation and Psychotherapy Services

A57520

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Draft Article
Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.

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General Information

Source Article ID
N/A
Article ID
A57520
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Psychiatric Diagnostic Evaluation and Psychotherapy Services
Article Type
Billing and Coding
Original Effective Date
10/03/2018
Revision Effective Date
01/01/2024
Revision Ending Date
N/A
Retirement Date
N/A
AMA CPT / ADA CDT / AHA NUBC Copyright Statement

CPT codes, descriptions and other data only are copyright 2023 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

Current Dental Terminology © 2023 American Dental Association. All rights reserved.

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CMS National Coverage Policy

Social Security Act (Title XVIII) Standard References:

  • Title XVIII of the Social Security Act, Section 1833(e) states that no payment shall be made to any provider of services or other person under this part unless there has been furnished such information as may be necessary in order to determine the amounts due such provider or other person under this part for the period with respect to which the amounts are being paid or for any prior period.

Article Guidance

Article Text

This Billing and Coding Article provides billing and coding guidance for Local Coverage Determination (LCD) L33252 Psychiatric Diagnostic Evaluation and Psychotherapy Services. Please refer to the LCD for reasonable and necessary requirements.

Coding Guidance

Notice: It is not appropriate to bill Medicare for services that are not covered (as described by the entire LCD) as if they are covered. When billing for non-covered services, use the appropriate modifier.

The psychotherapy for crisis CPT codes 90839 and 90840 are time-based codes used to report the total duration of time face-to-face with the patient and/or family spent by the physician or other qualified health care professional providing psychotherapy for crisis, even if the time spent on that date is not continuous. For any given period of time spent providing psychotherapy for crisis state, the physician or other qualified health care professional must devote his or her full attention to the patient and, therefore, cannot provide service to any other patient during the same time period. The patient must be present for all or some of the service. Do not report with CPT codes 90791 or 90792.

When a patient is referred with an organic diagnosis and a mental health diagnosis is established, the mental health diagnosis should be billed.

If a psychiatric diagnostic evaluation with medical assessment is performed, the physician or non-physician practitioner (NPP) may use CPT code 90792 or an evaluation and management (E/M) code.

If a patient is unable to communicate by any means, the interactive complexity CPT code 90785 should not be billed. This service is used in conjunction with codes for diagnostic psychiatric evaluation (CPT codes 90791, 90792), psychotherapy (CPT codes 90832, 90834, 90837), psychotherapy when performed with an E/M service (CPT codes 90833, 90836, 90838, 99202-99255, 99304-99310, 99341-99350), and group psychotherapy (CPT code 90853). When billed in conjunction with time-based codes, the documentation must indicate the amount of time spent in providing interactive complexity services.

Psychotherapy services (CPT codes 90832-90838) are time-based codes. Start and stop times or total times must be documented for CPT codes 90832, 90834, and 90837. For psychotherapy services performed with an E/M service (CPT codes 90833, 90836, and 90838), it is recognized that the psychotherapy time may not be continuous in a combined psychotherapy with an E/M service. However, since psychotherapy is a time-based code, the expectation would be documentation of the start and stop times or total time of the psychotherapy with an E/M service and documentation of the start and stop times or total time devoted to psychotherapy. The total time does not include the E/M time. Also note that when psychotherapy is performed with an E/M by the same physician or NPP, the documentation should show that they are separately identifiable services. Psychotherapy times are for face-to-face services with the patient. The patient must be present for all or some of the service. In reporting, choose the code closest to the actual time (i.e., 16-37 minutes for CPT codes 90832 and 90833, 38-52 minutes for CPT codes 90834 and 90836, and 53 or more minutes for CPT codes 90837 and 90838). Do not report psychotherapy of less than 16 minutes duration.

Prolonged services may not be reported when psychotherapy services billed with an E/M service (i.e., add-on CPT codes 90833, 90836, 90838) are reported. For CPT code 90837 (psychotherapy, 60 minutes with patient), a physician or other qualified health care professional can report a prolonged service code if the psychotherapy service, not performed with an E/M service, is 90 minutes or longer involving direct patient contact.

The psychoanalysis CPT code 90845 is not time-related, but the service is usually 45 to 50 minutes in duration. The code may be billed once for each daily session regardless of the time involved.

The CPT/HCPCS Group 1 codes G0017 and G0018 are for all non-facility places of service (POS) other than Office. 

Documentation Requirements

  1. All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
  2. Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service[s]). The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
  3. The submitted medical record must support the use of the selected ICD-10-CM code(s). The submitted CPT/HCPCS code must describe the service performed. 
  4. When the documentation of time is relevant for coding and payment purposes, time may be documented with start and stop times or with total time.

Response To Comments

Number Comment Response
1
N/A

Coding Information

Bill Type Codes

Code Description
999x Not Applicable
N/A

Revenue Codes

Code Description
99999 Not Applicable
N/A

CPT/HCPCS Codes

Group 1

(17 Codes)
Group 1 Paragraph

Note: Providers are reminded to refer to the long descriptors of the CPT codes in their CPT book.

Group 1 Codes
Code Description
90785 Psytx complex interactive
90791 Psych diagnostic evaluation
90792 Psych diag eval w/med srvcs
90832 Psytx w pt 30 minutes
90833 Psytx w pt w e/m 30 min
90834 Psytx w pt 45 minutes
90836 Psytx w pt w e/m 45 min
90837 Psytx w pt 60 minutes
90838 Psytx w pt w e/m 60 min
90839 Psytx crisis initial 60 min
90840 Psytx crisis ea addl 30 min
90845 Psychoanalysis
90846 Family psytx w/o pt 50 min
90847 Family psytx w/pt 50 min
90853 Group psychotherapy
G0017 Crisis psychotherapy 60m
G0018 Crisis psychotherapy add 30m
N/A

CPT/HCPCS Modifiers

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

(565 Codes)
Group 1 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT/HCPCS codes: 90785, 90791, 90792, 90832, 90833, 90834, 90836, 90837, 90838, 90839, 90840, 90845, 90846, 90847, 90853, G0017, and G0018.

Group 1 Codes
Code Description
F01.511 Vascular dementia, unspecified severity, with agitation
F01.518 Vascular dementia, unspecified severity, with other behavioral disturbance
F01.52 Vascular dementia, unspecified severity, with psychotic disturbance
F01.53 Vascular dementia, unspecified severity, with mood disturbance
F01.54 Vascular dementia, unspecified severity, with anxiety
F01.A0 Vascular dementia, mild, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety
F01.A11 Vascular dementia, mild, with agitation
F01.A18 Vascular dementia, mild, with other behavioral disturbance
F01.A2 Vascular dementia, mild, with psychotic disturbance
F01.A3 Vascular dementia, mild, with mood disturbance
F01.A4 Vascular dementia, mild, with anxiety
F01.B0 Vascular dementia, moderate, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety
F01.B11 Vascular dementia, moderate, with agitation
F01.B18 Vascular dementia, moderate, with other behavioral disturbance
F01.B2 Vascular dementia, moderate, with psychotic disturbance
F01.B3 Vascular dementia, moderate, with mood disturbance
F01.B4 Vascular dementia, moderate, with anxiety
F01.C0 Vascular dementia, severe, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety
F01.C11 Vascular dementia, severe, with agitation
F01.C18 Vascular dementia, severe, with other behavioral disturbance
F01.C2 Vascular dementia, severe, with psychotic disturbance
F01.C3 Vascular dementia, severe, with mood disturbance
F01.C4 Vascular dementia, severe, with anxiety
F02.80 Dementia in other diseases classified elsewhere, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety
F02.811 Dementia in other diseases classified elsewhere, unspecified severity, with agitation
F02.818 Dementia in other diseases classified elsewhere, unspecified severity, with other behavioral disturbance
F02.82 Dementia in other diseases classified elsewhere, unspecified severity, with psychotic disturbance
F02.83 Dementia in other diseases classified elsewhere, unspecified severity, with mood disturbance
F02.84 Dementia in other diseases classified elsewhere, unspecified severity, with anxiety
F02.A0 Dementia in other diseases classified elsewhere, mild, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety
F02.A11 Dementia in other diseases classified elsewhere, mild, with agitation
F02.A18 Dementia in other diseases classified elsewhere, mild, with other behavioral disturbance
F02.A2 Dementia in other diseases classified elsewhere, mild, with psychotic disturbance
F02.A3 Dementia in other diseases classified elsewhere, mild, with mood disturbance
F02.A4 Dementia in other diseases classified elsewhere, mild, with anxiety
F02.B0 Dementia in other diseases classified elsewhere, moderate, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety
F02.B11 Dementia in other diseases classified elsewhere, moderate, with agitation
F02.B18 Dementia in other diseases classified elsewhere, moderate, with other behavioral disturbance
F02.B2 Dementia in other diseases classified elsewhere, moderate, with psychotic disturbance
F02.B3 Dementia in other diseases classified elsewhere, moderate, with mood disturbance
F02.B4 Dementia in other diseases classified elsewhere, moderate, with anxiety
F02.C0 Dementia in other diseases classified elsewhere, severe, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety
F02.C11 Dementia in other diseases classified elsewhere, severe, with agitation
F02.C18 Dementia in other diseases classified elsewhere, severe, with other behavioral disturbance
F02.C2 Dementia in other diseases classified elsewhere, severe, with psychotic disturbance
F02.C3 Dementia in other diseases classified elsewhere, severe, with mood disturbance
F02.C4 Dementia in other diseases classified elsewhere, severe, with anxiety
F03.90 Unspecified dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety
F03.911 Unspecified dementia, unspecified severity, with agitation
F03.918 Unspecified dementia, unspecified severity, with other behavioral disturbance
F03.92 Unspecified dementia, unspecified severity, with psychotic disturbance
F03.93 Unspecified dementia, unspecified severity, with mood disturbance
F03.94 Unspecified dementia, unspecified severity, with anxiety
F03.A0 Unspecified dementia, mild, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety
F03.A11 Unspecified dementia, mild, with agitation
F03.A18 Unspecified dementia, mild, with other behavioral disturbance
F03.A2 Unspecified dementia, mild, with psychotic disturbance
F03.A3 Unspecified dementia, mild, with mood disturbance
F03.A4 Unspecified dementia, mild, with anxiety
F03.B0 Unspecified dementia, moderate, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety
F03.B11 Unspecified dementia, moderate, with agitation
F03.B18 Unspecified dementia, moderate, with other behavioral disturbance
F03.B2 Unspecified dementia, moderate, with psychotic disturbance
F03.B3 Unspecified dementia, moderate, with mood disturbance
F03.B4 Unspecified dementia, moderate, with anxiety
F03.C0 Unspecified dementia, severe, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety
F03.C11 Unspecified dementia, severe, with agitation
F03.C18 Unspecified dementia, severe, with other behavioral disturbance
F03.C2 Unspecified dementia, severe, with psychotic disturbance
F03.C3 Unspecified dementia, severe, with mood disturbance
F03.C4 Unspecified dementia, severe, with anxiety
F04 Amnestic disorder due to known physiological condition
F05 Delirium due to known physiological condition
F06.0 Psychotic disorder with hallucinations due to known physiological condition
F06.1 Catatonic disorder due to known physiological condition
F06.30 Mood disorder due to known physiological condition, unspecified
F06.31 Mood disorder due to known physiological condition with depressive features
F06.32 Mood disorder due to known physiological condition with major depressive-like episode
F06.33 Mood disorder due to known physiological condition with manic features
F06.34 Mood disorder due to known physiological condition with mixed features
F06.4 Anxiety disorder due to known physiological condition
F06.8 Other specified mental disorders due to known physiological condition
F07.0 Personality change due to known physiological condition
F07.81 Postconcussional syndrome
F07.89 Other personality and behavioral disorders due to known physiological condition
F07.9 Unspecified personality and behavioral disorder due to known physiological condition
F09 Unspecified mental disorder due to known physiological condition
F10.10 Alcohol abuse, uncomplicated
F10.11 Alcohol abuse, in remission
F10.120 Alcohol abuse with intoxication, uncomplicated
F10.121 Alcohol abuse with intoxication delirium
F10.129 Alcohol abuse with intoxication, unspecified
F10.130 Alcohol abuse with withdrawal, uncomplicated
F10.131 Alcohol abuse with withdrawal delirium
F10.132 Alcohol abuse with withdrawal with perceptual disturbance
F10.14 Alcohol abuse with alcohol-induced mood disorder
F10.150 Alcohol abuse with alcohol-induced psychotic disorder with delusions
F10.151 Alcohol abuse with alcohol-induced psychotic disorder with hallucinations
F10.159 Alcohol abuse with alcohol-induced psychotic disorder, unspecified
F10.180 Alcohol abuse with alcohol-induced anxiety disorder
F10.181 Alcohol abuse with alcohol-induced sexual dysfunction
F10.182 Alcohol abuse with alcohol-induced sleep disorder
F10.188 Alcohol abuse with other alcohol-induced disorder
F10.19 Alcohol abuse with unspecified alcohol-induced disorder
F10.20 Alcohol dependence, uncomplicated
F10.21 Alcohol dependence, in remission
F10.220 Alcohol dependence with intoxication, uncomplicated
F10.221 Alcohol dependence with intoxication delirium
F10.229 Alcohol dependence with intoxication, unspecified
F10.930 Alcohol use, unspecified with withdrawal, uncomplicated
F10.931 Alcohol use, unspecified with withdrawal delirium
F10.932 Alcohol use, unspecified with withdrawal with perceptual disturbance
F11.10 Opioid abuse, uncomplicated
F11.11 Opioid abuse, in remission
F11.120 Opioid abuse with intoxication, uncomplicated
F11.129 Opioid abuse with intoxication, unspecified
F11.13 Opioid abuse with withdrawal
F11.20 Opioid dependence, uncomplicated
F11.21 Opioid dependence, in remission
F11.220 Opioid dependence with intoxication, uncomplicated
F11.221 Opioid dependence with intoxication delirium
F11.222 Opioid dependence with intoxication with perceptual disturbance
F11.229 Opioid dependence with intoxication, unspecified
F11.23 Opioid dependence with withdrawal
F11.24 Opioid dependence with opioid-induced mood disorder
F11.250 Opioid dependence with opioid-induced psychotic disorder with delusions
F11.251 Opioid dependence with opioid-induced psychotic disorder with hallucinations
F11.259 Opioid dependence with opioid-induced psychotic disorder, unspecified
F11.281 Opioid dependence with opioid-induced sexual dysfunction
F11.282 Opioid dependence with opioid-induced sleep disorder
F11.288 Opioid dependence with other opioid-induced disorder
F11.29 Opioid dependence with unspecified opioid-induced disorder
F11.90 Opioid use, unspecified, uncomplicated
F11.91 Opioid use, unspecified, in remission
F12.10 Cannabis abuse, uncomplicated
F12.11 Cannabis abuse, in remission
F12.13 Cannabis abuse with withdrawal
F12.20 Cannabis dependence, uncomplicated
F12.21 Cannabis dependence, in remission
F12.220 Cannabis dependence with intoxication, uncomplicated
F12.221 Cannabis dependence with intoxication delirium
F12.222 Cannabis dependence with intoxication with perceptual disturbance
F12.229 Cannabis dependence with intoxication, unspecified
F12.23 Cannabis dependence with withdrawal
F12.250 Cannabis dependence with psychotic disorder with delusions
F12.251 Cannabis dependence with psychotic disorder with hallucinations
F12.259 Cannabis dependence with psychotic disorder, unspecified
F12.280 Cannabis dependence with cannabis-induced anxiety disorder
F12.288 Cannabis dependence with other cannabis-induced disorder
F12.29 Cannabis dependence with unspecified cannabis-induced disorder
F12.90 Cannabis use, unspecified, uncomplicated
F12.91 Cannabis use, unspecified, in remission
F12.93 Cannabis use, unspecified with withdrawal
F13.10 Sedative, hypnotic or anxiolytic abuse, uncomplicated
F13.11 Sedative, hypnotic or anxiolytic abuse, in remission
F13.120 Sedative, hypnotic or anxiolytic abuse with intoxication, uncomplicated
F13.130 Sedative, hypnotic or anxiolytic abuse with withdrawal, uncomplicated
F13.131 Sedative, hypnotic or anxiolytic abuse with withdrawal delirium
F13.132 Sedative, hypnotic or anxiolytic abuse with withdrawal with perceptual disturbance
F13.20 Sedative, hypnotic or anxiolytic dependence, uncomplicated
F13.21 Sedative, hypnotic or anxiolytic dependence, in remission
F13.220 Sedative, hypnotic or anxiolytic dependence with intoxication, uncomplicated
F13.221 Sedative, hypnotic or anxiolytic dependence with intoxication delirium
F13.229 Sedative, hypnotic or anxiolytic dependence with intoxication, unspecified
F13.230 Sedative, hypnotic or anxiolytic dependence with withdrawal, uncomplicated
F13.231 Sedative, hypnotic or anxiolytic dependence with withdrawal delirium
F13.232 Sedative, hypnotic or anxiolytic dependence with withdrawal with perceptual disturbance
F13.239 Sedative, hypnotic or anxiolytic dependence with withdrawal, unspecified
F13.24 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced mood disorder
F13.250 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced psychotic disorder with delusions
F13.251 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced psychotic disorder with hallucinations
F13.259 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced psychotic disorder, unspecified
F13.26 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced persisting amnestic disorder
F13.27 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced persisting dementia
F13.280 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced anxiety disorder
F13.281 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced sexual dysfunction
F13.282 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced sleep disorder
F13.288 Sedative, hypnotic or anxiolytic dependence with other sedative, hypnotic or anxiolytic-induced disorder
F13.29 Sedative, hypnotic or anxiolytic dependence with unspecified sedative, hypnotic or anxiolytic-induced disorder
F13.90 Sedative, hypnotic, or anxiolytic use, unspecified, uncomplicated
F13.91 Sedative, hypnotic or anxiolytic use, unspecified, in remission
F14.10 Cocaine abuse, uncomplicated
F14.11 Cocaine abuse, in remission
F14.120 Cocaine abuse with intoxication, uncomplicated
F14.13 Cocaine abuse, unspecified with withdrawal
F14.20 Cocaine dependence, uncomplicated
F14.21 Cocaine dependence, in remission
F14.220 Cocaine dependence with intoxication, uncomplicated
F14.221 Cocaine dependence with intoxication delirium
F14.222 Cocaine dependence with intoxication with perceptual disturbance
F14.229 Cocaine dependence with intoxication, unspecified
F14.23 Cocaine dependence with withdrawal
F14.24 Cocaine dependence with cocaine-induced mood disorder
F14.250 Cocaine dependence with cocaine-induced psychotic disorder with delusions
F14.251 Cocaine dependence with cocaine-induced psychotic disorder with hallucinations
F14.259 Cocaine dependence with cocaine-induced psychotic disorder, unspecified
F14.280 Cocaine dependence with cocaine-induced anxiety disorder
F14.281 Cocaine dependence with cocaine-induced sexual dysfunction
F14.282 Cocaine dependence with cocaine-induced sleep disorder
F14.288 Cocaine dependence with other cocaine-induced disorder
F14.29 Cocaine dependence with unspecified cocaine-induced disorder
F14.90 Cocaine use, unspecified, uncomplicated
F14.91 Cocaine use, unspecified, in remission
F14.93 Cocaine use, unspecified with withdrawal
F15.10 Other stimulant abuse, uncomplicated
F15.11 Other stimulant abuse, in remission
F15.120 Other stimulant abuse with intoxication, uncomplicated
F15.13 Other stimulant abuse with withdrawal
F15.20 Other stimulant dependence, uncomplicated
F15.21 Other stimulant dependence, in remission
F15.220 Other stimulant dependence with intoxication, uncomplicated
F15.221 Other stimulant dependence with intoxication delirium
F15.222 Other stimulant dependence with intoxication with perceptual disturbance
F15.229 Other stimulant dependence with intoxication, unspecified
F15.23 Other stimulant dependence with withdrawal
F15.24 Other stimulant dependence with stimulant-induced mood disorder
F15.250 Other stimulant dependence with stimulant-induced psychotic disorder with delusions
F15.251 Other stimulant dependence with stimulant-induced psychotic disorder with hallucinations
F15.259 Other stimulant dependence with stimulant-induced psychotic disorder, unspecified
F15.280 Other stimulant dependence with stimulant-induced anxiety disorder
F15.281 Other stimulant dependence with stimulant-induced sexual dysfunction
F15.282 Other stimulant dependence with stimulant-induced sleep disorder
F15.288 Other stimulant dependence with other stimulant-induced disorder
F15.29 Other stimulant dependence with unspecified stimulant-induced disorder
F15.90 Other stimulant use, unspecified, uncomplicated
F15.91 Other stimulant use, unspecified, in remission
F16.10 Hallucinogen abuse, uncomplicated
F16.11 Hallucinogen abuse, in remission
F16.120 Hallucinogen abuse with intoxication, uncomplicated
F16.20 Hallucinogen dependence, uncomplicated
F16.21 Hallucinogen dependence, in remission
F16.220 Hallucinogen dependence with intoxication, uncomplicated
F16.221 Hallucinogen dependence with intoxication with delirium
F16.229 Hallucinogen dependence with intoxication, unspecified
F16.24 Hallucinogen dependence with hallucinogen-induced mood disorder
F16.250 Hallucinogen dependence with hallucinogen-induced psychotic disorder with delusions
F16.251 Hallucinogen dependence with hallucinogen-induced psychotic disorder with hallucinations
F16.259 Hallucinogen dependence with hallucinogen-induced psychotic disorder, unspecified
F16.280 Hallucinogen dependence with hallucinogen-induced anxiety disorder
F16.283 Hallucinogen dependence with hallucinogen persisting perception disorder (flashbacks)
F16.288 Hallucinogen dependence with other hallucinogen-induced disorder
F16.29 Hallucinogen dependence with unspecified hallucinogen-induced disorder
F16.90 Hallucinogen use, unspecified, uncomplicated
F16.91 Hallucinogen use, unspecified, in remission
F17.200 Nicotine dependence, unspecified, uncomplicated
F17.201 Nicotine dependence, unspecified, in remission
F17.210 Nicotine dependence, cigarettes, uncomplicated
F17.211 Nicotine dependence, cigarettes, in remission
F17.220 Nicotine dependence, chewing tobacco, uncomplicated
F17.221 Nicotine dependence, chewing tobacco, in remission
F17.290 Nicotine dependence, other tobacco product, uncomplicated
F17.291 Nicotine dependence, other tobacco product, in remission
F18.10 Inhalant abuse, uncomplicated
F18.11 Inhalant abuse, in remission
F18.120 Inhalant abuse with intoxication, uncomplicated
F18.20 Inhalant dependence, uncomplicated
F18.21 Inhalant dependence, in remission
F18.220 Inhalant dependence with intoxication, uncomplicated
F18.221 Inhalant dependence with intoxication delirium
F18.229 Inhalant dependence with intoxication, unspecified
F18.24 Inhalant dependence with inhalant-induced mood disorder
F18.250 Inhalant dependence with inhalant-induced psychotic disorder with delusions
F18.251 Inhalant dependence with inhalant-induced psychotic disorder with hallucinations
F18.259 Inhalant dependence with inhalant-induced psychotic disorder, unspecified
F18.27 Inhalant dependence with inhalant-induced dementia
F18.280 Inhalant dependence with inhalant-induced anxiety disorder
F18.288 Inhalant dependence with other inhalant-induced disorder
F18.29 Inhalant dependence with unspecified inhalant-induced disorder
F18.90 Inhalant use, unspecified, uncomplicated
F18.91 Inhalant use, unspecified, in remission
F19.10 Other psychoactive substance abuse, uncomplicated
F19.11 Other psychoactive substance abuse, in remission
F19.120 Other psychoactive substance abuse with intoxication, uncomplicated
F19.130 Other psychoactive substance abuse with withdrawal, uncomplicated
F19.131 Other psychoactive substance abuse with withdrawal delirium
F19.132 Other psychoactive substance abuse with withdrawal with perceptual disturbance
F19.20 Other psychoactive substance dependence, uncomplicated
F19.21 Other psychoactive substance dependence, in remission
F19.220 Other psychoactive substance dependence with intoxication, uncomplicated
F19.221 Other psychoactive substance dependence with intoxication delirium
F19.222 Other psychoactive substance dependence with intoxication with perceptual disturbance
F19.229 Other psychoactive substance dependence with intoxication, unspecified
F19.230 Other psychoactive substance dependence with withdrawal, uncomplicated
F19.231 Other psychoactive substance dependence with withdrawal delirium
F19.232 Other psychoactive substance dependence with withdrawal with perceptual disturbance
F19.239 Other psychoactive substance dependence with withdrawal, unspecified
F19.24 Other psychoactive substance dependence with psychoactive substance-induced mood disorder
F19.250 Other psychoactive substance dependence with psychoactive substance-induced psychotic disorder with delusions
F19.251 Other psychoactive substance dependence with psychoactive substance-induced psychotic disorder with hallucinations
F19.259 Other psychoactive substance dependence with psychoactive substance-induced psychotic disorder, unspecified
F19.26 Other psychoactive substance dependence with psychoactive substance-induced persisting amnestic disorder
F19.27 Other psychoactive substance dependence with psychoactive substance-induced persisting dementia
F19.280 Other psychoactive substance dependence with psychoactive substance-induced anxiety disorder
F19.281 Other psychoactive substance dependence with psychoactive substance-induced sexual dysfunction
F19.282 Other psychoactive substance dependence with psychoactive substance-induced sleep disorder
F19.288 Other psychoactive substance dependence with other psychoactive substance-induced disorder
F19.29 Other psychoactive substance dependence with unspecified psychoactive substance-induced disorder
F19.90 Other psychoactive substance use, unspecified, uncomplicated
F19.91 Other psychoactive substance use, unspecified, in remission
F20.0 Paranoid schizophrenia
F20.1 Disorganized schizophrenia
F20.2 Catatonic schizophrenia
F20.3 Undifferentiated schizophrenia
F20.5 Residual schizophrenia
F20.81 Schizophreniform disorder
F20.89 Other schizophrenia
F21 Schizotypal disorder
F22 Delusional disorders
F23 Brief psychotic disorder
F24 Shared psychotic disorder
F25.0 Schizoaffective disorder, bipolar type
F25.1 Schizoaffective disorder, depressive type
F25.8 Other schizoaffective disorders
F30.10 Manic episode without psychotic symptoms, unspecified
F30.11 Manic episode without psychotic symptoms, mild
F30.12 Manic episode without psychotic symptoms, moderate
F30.13 Manic episode, severe, without psychotic symptoms
F30.2 Manic episode, severe with psychotic symptoms
F30.3 Manic episode in partial remission
F30.4 Manic episode in full remission
F30.8 Other manic episodes
F31.0 Bipolar disorder, current episode hypomanic
F31.10 Bipolar disorder, current episode manic without psychotic features, unspecified
F31.11 Bipolar disorder, current episode manic without psychotic features, mild
F31.12 Bipolar disorder, current episode manic without psychotic features, moderate
F31.13 Bipolar disorder, current episode manic without psychotic features, severe
F31.2 Bipolar disorder, current episode manic severe with psychotic features
F31.30 Bipolar disorder, current episode depressed, mild or moderate severity, unspecified
F31.31 Bipolar disorder, current episode depressed, mild
F31.32 Bipolar disorder, current episode depressed, moderate
F31.4 Bipolar disorder, current episode depressed, severe, without psychotic features
F31.5 Bipolar disorder, current episode depressed, severe, with psychotic features
F31.60 Bipolar disorder, current episode mixed, unspecified
F31.61 Bipolar disorder, current episode mixed, mild
F31.62 Bipolar disorder, current episode mixed, moderate
F31.63 Bipolar disorder, current episode mixed, severe, without psychotic features
F31.64 Bipolar disorder, current episode mixed, severe, with psychotic features
F31.81 Bipolar II disorder
F31.89 Other bipolar disorder
F32.0 Major depressive disorder, single episode, mild
F32.1 Major depressive disorder, single episode, moderate
F32.2 Major depressive disorder, single episode, severe without psychotic features
F32.3 Major depressive disorder, single episode, severe with psychotic features
F32.4 Major depressive disorder, single episode, in partial remission
F32.5 Major depressive disorder, single episode, in full remission
F32.81 Premenstrual dysphoric disorder
F32.89 Other specified depressive episodes
F32.A Depression, unspecified
F33.0 Major depressive disorder, recurrent, mild
F33.1 Major depressive disorder, recurrent, moderate
F33.2 Major depressive disorder, recurrent severe without psychotic features
F33.3 Major depressive disorder, recurrent, severe with psychotic symptoms
F33.40 Major depressive disorder, recurrent, in remission, unspecified
F33.41 Major depressive disorder, recurrent, in partial remission
F33.42 Major depressive disorder, recurrent, in full remission
F33.8 Other recurrent depressive disorders
F34.0 Cyclothymic disorder
F34.1 Dysthymic disorder
F34.81 Disruptive mood dysregulation disorder
F34.89 Other specified persistent mood disorders
F40.01 Agoraphobia with panic disorder
F40.02 Agoraphobia without panic disorder
F40.10 Social phobia, unspecified
F40.11 Social phobia, generalized
F40.210 Arachnophobia
F40.218 Other animal type phobia
F40.220 Fear of thunderstorms
F40.228 Other natural environment type phobia
F40.230 Fear of blood
F40.231 Fear of injections and transfusions
F40.232 Fear of other medical care
F40.233 Fear of injury
F40.240 Claustrophobia
F40.241 Acrophobia
F40.242 Fear of bridges
F40.243 Fear of flying
F40.248 Other situational type phobia
F40.290 Androphobia
F40.291 Gynephobia
F40.298 Other specified phobia
F40.8 Other phobic anxiety disorders
F41.0 Panic disorder [episodic paroxysmal anxiety]
F41.1 Generalized anxiety disorder
F41.3 Other mixed anxiety disorders
F41.8 Other specified anxiety disorders
F42.2 Mixed obsessional thoughts and acts
F42.3 Hoarding disorder
F42.4 Excoriation (skin-picking) disorder
F42.8 Other obsessive-compulsive disorder
F42.9 Obsessive-compulsive disorder, unspecified
F43.0 Acute stress reaction
F43.10 Post-traumatic stress disorder, unspecified
F43.11 Post-traumatic stress disorder, acute
F43.12 Post-traumatic stress disorder, chronic
F43.20 Adjustment disorder, unspecified
F43.21 Adjustment disorder with depressed mood
F43.22 Adjustment disorder with anxiety
F43.23 Adjustment disorder with mixed anxiety and depressed mood
F43.24 Adjustment disorder with disturbance of conduct
F43.25 Adjustment disorder with mixed disturbance of emotions and conduct
F43.29 Adjustment disorder with other symptoms
F43.89 Other reactions to severe stress
F44.0 Dissociative amnesia
F44.1 Dissociative fugue
F44.2 Dissociative stupor
F44.4 Conversion disorder with motor symptom or deficit
F44.5 Conversion disorder with seizures or convulsions
F44.6 Conversion disorder with sensory symptom or deficit
F44.7 Conversion disorder with mixed symptom presentation
F44.81 Dissociative identity disorder
F44.89 Other dissociative and conversion disorders
F45.0 Somatization disorder
F45.1 Undifferentiated somatoform disorder
F45.20 Hypochondriacal disorder, unspecified
F45.21 Hypochondriasis
F45.22 Body dysmorphic disorder
F45.29 Other hypochondriacal disorders
F45.41 Pain disorder exclusively related to psychological factors
F45.42 Pain disorder with related psychological factors
F45.8 Other somatoform disorders
F48.1 Depersonalization-derealization syndrome
F48.2 Pseudobulbar affect
F48.8 Other specified nonpsychotic mental disorders
F50.00 Anorexia nervosa, unspecified
F50.01 Anorexia nervosa, restricting type
F50.02 Anorexia nervosa, binge eating/purging type
F50.2 Bulimia nervosa
F50.81 Binge eating disorder
F50.82 Avoidant/restrictive food intake disorder
F50.89 Other specified eating disorder
F51.01 Primary insomnia
F51.02 Adjustment insomnia
F51.03 Paradoxical insomnia
F51.04 Psychophysiologic insomnia
F51.05 Insomnia due to other mental disorder
F51.09 Other insomnia not due to a substance or known physiological condition
F51.11 Primary hypersomnia
F51.12 Insufficient sleep syndrome
F51.13 Hypersomnia due to other mental disorder
F51.19 Other hypersomnia not due to a substance or known physiological condition
F51.3 Sleepwalking [somnambulism]
F51.4 Sleep terrors [night terrors]
F51.5 Nightmare disorder
F51.8 Other sleep disorders not due to a substance or known physiological condition
F52.0 Hypoactive sexual desire disorder
F52.1 Sexual aversion disorder
F52.21 Male erectile disorder
F52.22 Female sexual arousal disorder
F52.31 Female orgasmic disorder
F52.32 Male orgasmic disorder
F52.4 Premature ejaculation
F52.5 Vaginismus not due to a substance or known physiological condition
F52.6 Dyspareunia not due to a substance or known physiological condition
F52.8 Other sexual dysfunction not due to a substance or known physiological condition
F53.0 Postpartum depression
F53.1 Puerperal psychosis
F54 Psychological and behavioral factors associated with disorders or diseases classified elsewhere
F55.0 Abuse of antacids
F55.1 Abuse of herbal or folk remedies
F55.2 Abuse of laxatives
F55.3 Abuse of steroids or hormones
F55.4 Abuse of vitamins
F55.8 Abuse of other non-psychoactive substances
F59 Unspecified behavioral syndromes associated with physiological disturbances and physical factors
F60.0 Paranoid personality disorder
F60.1 Schizoid personality disorder
F60.2 Antisocial personality disorder
F60.3 Borderline personality disorder
F60.4 Histrionic personality disorder
F60.5 Obsessive-compulsive personality disorder
F60.6 Avoidant personality disorder
F60.7 Dependent personality disorder
F60.81 Narcissistic personality disorder
F60.89 Other specific personality disorders
F60.9 Personality disorder, unspecified
F63.0 Pathological gambling
F63.1 Pyromania
F63.2 Kleptomania
F63.3 Trichotillomania
F63.81 Intermittent explosive disorder
F63.89 Other impulse disorders
F63.9 Impulse disorder, unspecified
F64.0 Transsexualism
F64.1 Dual role transvestism
F64.2 Gender identity disorder of childhood
F64.8 Other gender identity disorders
F64.9 Gender identity disorder, unspecified
F65.0 Fetishism
F65.1 Transvestic fetishism
F65.2 Exhibitionism
F65.3 Voyeurism
F65.4 Pedophilia
F65.50 Sadomasochism, unspecified
F65.51 Sexual masochism
F65.52 Sexual sadism
F65.81 Frotteurism
F65.89 Other paraphilias
F65.9 Paraphilia, unspecified
F66 Other sexual disorders
F68.10 Factitious disorder imposed on self, unspecified
F68.11 Factitious disorder imposed on self, with predominantly psychological signs and symptoms
F68.12 Factitious disorder imposed on self, with predominantly physical signs and symptoms
F68.13 Factitious disorder imposed on self, with combined psychological and physical signs and symptoms
F68.A Factitious disorder imposed on another
F68.8 Other specified disorders of adult personality and behavior
F69 Unspecified disorder of adult personality and behavior
F70 Mild intellectual disabilities
F71 Moderate intellectual disabilities
F72 Severe intellectual disabilities
F73 Profound intellectual disabilities
F80.0 Phonological disorder
F80.1 Expressive language disorder
F80.2 Mixed receptive-expressive language disorder
F80.4 Speech and language development delay due to hearing loss
F80.81 Childhood onset fluency disorder
F80.82 Social pragmatic communication disorder
F80.89 Other developmental disorders of speech and language
F80.9 Developmental disorder of speech and language, unspecified
F81.0 Specific reading disorder
F81.2 Mathematics disorder
F81.81 Disorder of written expression
F81.89 Other developmental disorders of scholastic skills
F81.9 Developmental disorder of scholastic skills, unspecified
F82 Specific developmental disorder of motor function
F88 Other disorders of psychological development
F89 Unspecified disorder of psychological development
F90.0 Attention-deficit hyperactivity disorder, predominantly inattentive type
F90.1 Attention-deficit hyperactivity disorder, predominantly hyperactive type
F90.2 Attention-deficit hyperactivity disorder, combined type
F90.8 Attention-deficit hyperactivity disorder, other type
F90.9 Attention-deficit hyperactivity disorder, unspecified type
F91.0 Conduct disorder confined to family context
F91.1 Conduct disorder, childhood-onset type
F91.2 Conduct disorder, adolescent-onset type
F91.3 Oppositional defiant disorder
F91.8 Other conduct disorders
F91.9 Conduct disorder, unspecified
F93.0 Separation anxiety disorder of childhood
F93.8 Other childhood emotional disorders
F93.9 Childhood emotional disorder, unspecified
F94.0 Selective mutism
F94.1 Reactive attachment disorder of childhood
F94.2 Disinhibited attachment disorder of childhood
F94.8 Other childhood disorders of social functioning
F94.9 Childhood disorder of social functioning, unspecified
F95.0 Transient tic disorder
F95.1 Chronic motor or vocal tic disorder
F95.2 Tourette's disorder
F95.8 Other tic disorders
F95.9 Tic disorder, unspecified
F98.0 Enuresis not due to a substance or known physiological condition
F98.1 Encopresis not due to a substance or known physiological condition
F98.21 Rumination disorder of infancy
F98.29 Other feeding disorders of infancy and early childhood
F98.3 Pica of infancy and childhood
F98.4 Stereotyped movement disorders
F98.5 Adult onset fluency disorder
F98.8 Other specified behavioral and emotional disorders with onset usually occurring in childhood and adolescence
F98.9 Unspecified behavioral and emotional disorders with onset usually occurring in childhood and adolescence
F99 Mental disorder, not otherwise specified
G30.0 Alzheimer's disease with early onset
G30.1 Alzheimer's disease with late onset
G30.8 Other Alzheimer's disease
G30.9 Alzheimer's disease, unspecified
Z01.818 Encounter for other preprocedural examination
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ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

(1 Code)
Group 1 Paragraph

All those not listed under the “ICD-10-CM Codes that Support Medical Necessity” section of this article.

Group 1 Codes
Code Description
XX000 Not Applicable
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ICD-10-PCS Codes

Group 1

Group 1 Paragraph

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Group 1 Codes

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Additional ICD-10 Information

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Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

Code Description
999x Not Applicable
N/A

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

Code Description
99999 Not Applicable
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Other Coding Information

Group 1

Group 1 Paragraph

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Group 1 Codes

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Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
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Non-Excluded CPT/HCPCS Ended Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
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Revision History Information

Revision History Date Revision History Number Revision History Explanation
01/01/2024 R6

Article revised and published on 01/25/2024 effective for dates of service on and after 01/01/2024 to reflect the Annual HCPCS/CPT Code Updates. The following codes have been added to Group 1 codes: G0017, G0018. Some guidance has been added under Article Text and G0017, G0018 have been added to the ICD-10-CM Group 1 paragraph list of codes. 

01/01/2023 R5

Article revised and published on 01/26/2023 effective for dates of service on and after 01/01/2023 to reflect the Annual HCPCS/CPT Code Updates. Evaluation and Management (E/M) codes 99334, 99335, 99336 and 99337 have been deleted; therefore, the following sentence (2nd sentence in the 5th paragraph under the 'Coding Guidance' section) has been revised: This service is used in conjunction with codes for diagnostic psychiatric evaluation (CPT codes 90791, 90792), psychotherapy (CPT codes 90832, 90834, 90837), psychotherapy when performed with an E/M service (CPT codes 90833, 90836, 90838, 99202-99255, 99304-99337, 99341-99350), and group psychotherapy (CPT code 90853). This sentence has been revised to: This service is used in conjunction with codes for diagnostic psychiatric evaluation (CPT codes 90791, 90792), psychotherapy (CPT codes 90832, 90834, 90837), psychotherapy when performed with an E/M service (CPT codes 90833, 90836, 90838, 99202-99255, 99304-99310, 99341-99350), and group psychotherapy (CPT code 90853).

10/01/2022 R4

Article revised and published on 10/20/2022 effective for dates of service on and after 10/01/2022 to reflect the Annual ICD-10-CM Code Updates. The following ICD-10-CM codes have been added to the article: F01.511, F01.518, F01.52, F01.53, F01.54, F01.A0, F01.A11, F01.A18, F01.A2, F01.A3, F01.A4, F01.B0, F01.B11, F01.B18, F01.B2, F01.B3, F01.B4, F01.C0, F01.C11, F01.C18, F01.C2, F01.C3, F01.C4, F02.811, F02.818, F02.82, F02.83, F02.84, F02.A0, F02.A11, F02.A18, F02.A2, F02.A3, F02.A4, F02.B0, F02.B11, F02.B18, F02.B2, F02.B3, F02.B4, F02.C0, F02.C11, F02.C18, F02.C2, F02.C3, F02.C4, F03.911, F03.918, F03.92, F03.93, F03.94, F03.A0, F03.A11, F03.A18, F03.A2, F03.A3, F03.A4, F03.B0, F03.B11, F03.B18, F03.B2, F03.B3, F03.B4, F03.C0, F03.C11, F03.C18, F03.C2, F03.C3, F03.C4, F11.91, F12.91, F13.91, F14.91, F15.91, F16.91, F18.91, F19.91, F43.89 in Group 1. The following ICD-10-CM codes have been deleted and therefore have been removed from the article: F01.51, F02.81, F03.91, F43.8 in Group 1. For the following ICD-10-CM codes the code description has changed: F02.80, F03.90 in Group 1.

10/01/2021 R3

Article revised and published on 10/14/2021 effective for dates of service on and after 10/01/2021 to reflect the Annual ICD-10-CM Code Updates.

The following ICD-10-CM code has been added to the Article: F32.A

05/13/2021 R2

Article revised and published on 05/13/2021. Article revised in the fourth paragraph in the "Coding Guidance" and in the "Documentation Requirements" sections to clarify that time-based services must be documented with start and stop times or total times. Reference to CPT code 99201 has been removed from the third paragraph in the "Coding Guidance" section since 99201 has been deleted.

Minor formatting changes made throughout the article.

10/01/2020 R1

Revision Number: 1
Publication: September 2020 Connection
LCR A/B2020-065

Explanation of Revision: The following ICD-10-CM code(s) have been added to the “ICD-10 Codes that Support Medical Necessity/Group 1 Paragraph” section: F10.130, F10.131, F10.132, F10.930, F10.931, F10.932, F11.13, F12.13, F13.130, F13.131, F13.132, F14.13, F14.93, F15.13, F19.130, F19.131 and F19.132. Article revised and published on 10/01/2020 effective for dates of service on and after 10/01/2020 to reflect the Annual ICD-10-CM code updates.

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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related National Coverage Documents
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SAD Process URL 1
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SAD Process URL 2
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Statutory Requirements URLs
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Rules and Regulations URLs
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CMS Manual Explanations URLs
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Other URLs
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Public Versions
Updated On Effective Dates Status
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Keywords

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