LCD Reference Article Billing and Coding Article

Billing and Coding: Home Health - Psychiatric Care

A56756

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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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Source Article ID
N/A
Article ID
A56756
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Home Health - Psychiatric Care
Article Type
Billing and Coding
Original Effective Date
08/01/2019
Revision Effective Date
11/09/2023
Revision Ending Date
N/A
Retirement Date
N/A

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CMS National Coverage Policy

Title XVIII of the Social Security Act, §1833(e) prohibits Medicare payment for any claim lacking the necessary documentation to process the claim.

CMS Internet-Only Manual, Pub. 100-04, Medicare Claims Processing Manual, Chapter 10, §40.2 HH PPS Claims

CMS Internet-Only Manual, Pub. 100-08, Medicare Program Integrity Manual, Chapter 6, §6.2.4 Coding and §6.2.7 Medical Review of Home Health Demand Bills

Article Guidance

Article Text

The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Home Health - Psychiatric Care L34561.

Diagnostic Criteria

A Patient must have a diagnosis as defined in the Diagnostic and Statistical Manual of Mental Health Disorders, 5th Edition, DSM-5™. This diagnosis must match the diagnosis that the ordering physician is treating and/or for which the patient was hospitalized. This diagnosis must be fully documented and available in the medical record.

The DSM-5™ has combined Axis III with Axes I and II. Clinicians should continue to list medical conditions that are important to the understanding or management of an individual's mental disorder as opposed to personality disorders, mental retardation, general medical conditions, psychosocial and environmental problems and global assessment of functioning.

Billing When Separate Visits Were Made for Medical and Psychiatric Nursing Care

Psychiatric nursing care is not separately billable from non-psychiatric nursing care. Both of these services constitute skilled nursing care and may be furnished by the psychiatric nurse, in the course of a single visit. Therefore, visits will not be covered for 1 nurse to provide psychiatric nursing care and another to provide non-psychiatric nursing care, unless the non-psychiatric nursing care is of such a highly specialized and technical nature, that the service could not be safely rendered by the psychiatric nurse (e.g., infusion therapy).

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Group 1

Group 1 Paragraph

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Group 1 Codes

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ICD-10-CM Codes that Support Medical Necessity

Group 1

(595 Codes)
Group 1 Paragraph

Patients must have an Axis I Diagnosis as defined in the DSM-5™.

 

Group 1 Codes
Code Description
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.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.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
F06.0 Psychotic disorder with hallucinations due to known physiological condition
F06.1 Catatonic disorder due to known physiological condition
F06.2 Psychotic disorder with delusions 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
F06.71 Mild neurocognitive disorder due to known physiological condition with behavioral disturbance
F06.8 Other specified mental disorders due to known physiological condition
F07.89 Other personality and behavioral disorders due to known physiological condition
F10.121 Alcohol abuse with intoxication delirium
F10.130 Alcohol abuse with withdrawal, uncomplicated
F10.131 Alcohol abuse with withdrawal delirium
F10.132 Alcohol abuse with withdrawal with perceptual disturbance
F10.139 Alcohol abuse with withdrawal, unspecified
F10.14 Alcohol abuse with alcohol-induced mood disorder
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
F10.188 Alcohol abuse with other alcohol-induced disorder
F10.221 Alcohol dependence with intoxication delirium
F10.230 Alcohol dependence with withdrawal, uncomplicated
F10.231 Alcohol dependence with withdrawal delirium
F10.232 Alcohol dependence with withdrawal with perceptual disturbance
F10.239 Alcohol dependence with withdrawal, unspecified
F10.24 Alcohol dependence with alcohol-induced mood disorder
F10.259 Alcohol dependence with alcohol-induced psychotic disorder, unspecified
F10.26 Alcohol dependence with alcohol-induced persisting amnestic disorder
F10.27 Alcohol dependence with alcohol-induced persisting dementia
F10.280 Alcohol dependence with alcohol-induced anxiety disorder
F10.281 Alcohol dependence with alcohol-induced sexual dysfunction
F10.288 Alcohol dependence with other alcohol-induced disorder
F10.90 Alcohol use, unspecified, uncomplicated
F10.91 Alcohol use, unspecified, in remission
F10.921 Alcohol use, unspecified with intoxication delirium
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
F10.939 Alcohol use, unspecified with withdrawal, unspecified
F10.959 Alcohol use, unspecified with alcohol-induced psychotic disorder, unspecified
F10.96 Alcohol use, unspecified with alcohol-induced persisting amnestic disorder
F10.97 Alcohol use, unspecified with alcohol-induced persisting dementia
F10.980 Alcohol use, unspecified with alcohol-induced anxiety disorder
F10.981 Alcohol use, unspecified with alcohol-induced sexual dysfunction
F10.988 Alcohol use, unspecified with other alcohol-induced disorder
F11.121 Opioid abuse with intoxication delirium
F11.122 Opioid abuse with intoxication with perceptual disturbance
F11.13 Opioid abuse with withdrawal
F11.14 Opioid abuse with opioid-induced mood disorder
F11.150 Opioid abuse with opioid-induced psychotic disorder with delusions
F11.151 Opioid abuse with opioid-induced psychotic disorder with hallucinations
F11.159 Opioid abuse with opioid-induced psychotic disorder, unspecified
F11.181 Opioid abuse with opioid-induced sexual dysfunction
F11.182 Opioid abuse with opioid-induced sleep disorder
F11.188 Opioid abuse with other opioid-induced disorder
F11.19 Opioid abuse with unspecified opioid-induced disorder
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
F11.91 Opioid use, unspecified, in remission
F11.920 Opioid use, unspecified with intoxication, uncomplicated
F11.921 Opioid use, unspecified with intoxication delirium
F11.922 Opioid use, unspecified with intoxication with perceptual disturbance
F11.929 Opioid use, unspecified with intoxication, unspecified
F11.93 Opioid use, unspecified with withdrawal
F11.94 Opioid use, unspecified with opioid-induced mood disorder
F11.950 Opioid use, unspecified with opioid-induced psychotic disorder with delusions
F11.951 Opioid use, unspecified with opioid-induced psychotic disorder with hallucinations
F11.959 Opioid use, unspecified with opioid-induced psychotic disorder, unspecified
F11.981 Opioid use, unspecified with opioid-induced sexual dysfunction
F11.982 Opioid use, unspecified with opioid-induced sleep disorder
F11.988 Opioid use, unspecified with other opioid-induced disorder
F11.99 Opioid use, unspecified with unspecified opioid-induced disorder
F12.120 Cannabis abuse with intoxication, uncomplicated
F12.121 Cannabis abuse with intoxication delirium
F12.122 Cannabis abuse with intoxication with perceptual disturbance
F12.129 Cannabis abuse with intoxication, unspecified
F12.13 Cannabis abuse with withdrawal
F12.150 Cannabis abuse with psychotic disorder with delusions
F12.151 Cannabis abuse with psychotic disorder with hallucinations
F12.159 Cannabis abuse with psychotic disorder, unspecified
F12.180 Cannabis abuse with cannabis-induced anxiety disorder
F12.188 Cannabis abuse with other cannabis-induced disorder
F12.19 Cannabis abuse with unspecified cannabis-induced disorder
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
F12.91 Cannabis use, unspecified, in remission
F12.920 Cannabis use, unspecified with intoxication, uncomplicated
F12.921 Cannabis use, unspecified with intoxication delirium
F12.922 Cannabis use, unspecified with intoxication with perceptual disturbance
F12.929 Cannabis use, unspecified with intoxication, unspecified
F12.93 Cannabis use, unspecified with withdrawal
F12.950 Cannabis use, unspecified with psychotic disorder with delusions
F12.951 Cannabis use, unspecified with psychotic disorder with hallucinations
F12.959 Cannabis use, unspecified with psychotic disorder, unspecified
F12.980 Cannabis use, unspecified with anxiety disorder
F12.988 Cannabis use, unspecified with other cannabis-induced disorder
F12.99 Cannabis use, unspecified with unspecified cannabis-induced disorder
F13.121 Sedative, hypnotic or anxiolytic abuse with intoxication delirium
F13.129 Sedative, hypnotic or anxiolytic abuse with intoxication, unspecified
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
F13.139 Sedative, hypnotic or anxiolytic abuse with withdrawal, unspecified
F13.14 Sedative, hypnotic or anxiolytic abuse with sedative, hypnotic or anxiolytic-induced mood disorder
F13.150 Sedative, hypnotic or anxiolytic abuse with sedative, hypnotic or anxiolytic-induced psychotic disorder with delusions
F13.151 Sedative, hypnotic or anxiolytic abuse with sedative, hypnotic or anxiolytic-induced psychotic disorder with hallucinations
F13.159 Sedative, hypnotic or anxiolytic abuse with sedative, hypnotic or anxiolytic-induced psychotic disorder, unspecified
F13.180 Sedative, hypnotic or anxiolytic abuse with sedative, hypnotic or anxiolytic-induced anxiety disorder
F13.181 Sedative, hypnotic or anxiolytic abuse with sedative, hypnotic or anxiolytic-induced sexual dysfunction
F13.182 Sedative, hypnotic or anxiolytic abuse with sedative, hypnotic or anxiolytic-induced sleep disorder
F13.188 Sedative, hypnotic or anxiolytic abuse with other sedative, hypnotic or anxiolytic-induced disorder
F13.19 Sedative, hypnotic or anxiolytic abuse with unspecified sedative, hypnotic or anxiolytic-induced disorder
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
F13.91 Sedative, hypnotic or anxiolytic use, unspecified, in remission
F13.920 Sedative, hypnotic or anxiolytic use, unspecified with intoxication, uncomplicated
F13.921 Sedative, hypnotic or anxiolytic use, unspecified with intoxication delirium
F13.929 Sedative, hypnotic or anxiolytic use, unspecified with intoxication, unspecified
F13.930 Sedative, hypnotic or anxiolytic use, unspecified with withdrawal, uncomplicated
F13.931 Sedative, hypnotic or anxiolytic use, unspecified with withdrawal delirium
F13.932 Sedative, hypnotic or anxiolytic use, unspecified with withdrawal with perceptual disturbances
F13.939 Sedative, hypnotic or anxiolytic use, unspecified with withdrawal, unspecified
F13.94 Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced mood disorder
F13.950 Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced psychotic disorder with delusions
F13.951 Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced psychotic disorder with hallucinations
F13.959 Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced psychotic disorder, unspecified
F13.96 Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced persisting amnestic disorder
F13.97 Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced persisting dementia
F13.980 Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced anxiety disorder
F13.981 Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced sexual dysfunction
F13.982 Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced sleep disorder
F13.988 Sedative, hypnotic or anxiolytic use, unspecified with other sedative, hypnotic or anxiolytic-induced disorder
F13.99 Sedative, hypnotic or anxiolytic use, unspecified with unspecified sedative, hypnotic or anxiolytic-induced disorder
F14.121 Cocaine abuse with intoxication with delirium
F14.122 Cocaine abuse with intoxication with perceptual disturbance
F14.129 Cocaine abuse with intoxication, unspecified
F14.13 Cocaine abuse, unspecified with withdrawal
F14.14 Cocaine abuse with cocaine-induced mood disorder
F14.150 Cocaine abuse with cocaine-induced psychotic disorder with delusions
F14.151 Cocaine abuse with cocaine-induced psychotic disorder with hallucinations
F14.159 Cocaine abuse with cocaine-induced psychotic disorder, unspecified
F14.180 Cocaine abuse with cocaine-induced anxiety disorder
F14.181 Cocaine abuse with cocaine-induced sexual dysfunction
F14.182 Cocaine abuse with cocaine-induced sleep disorder
F14.188 Cocaine abuse with other cocaine-induced disorder
F14.19 Cocaine abuse with unspecified cocaine-induced disorder
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
F14.91 Cocaine use, unspecified, in remission
F14.920 Cocaine use, unspecified with intoxication, uncomplicated
F14.921 Cocaine use, unspecified with intoxication delirium
F14.922 Cocaine use, unspecified with intoxication with perceptual disturbance
F14.929 Cocaine use, unspecified with intoxication, unspecified
F14.93 Cocaine use, unspecified with withdrawal
F14.94 Cocaine use, unspecified with cocaine-induced mood disorder
F14.950 Cocaine use, unspecified with cocaine-induced psychotic disorder with delusions
F14.951 Cocaine use, unspecified with cocaine-induced psychotic disorder with hallucinations
F14.959 Cocaine use, unspecified with cocaine-induced psychotic disorder, unspecified
F14.980 Cocaine use, unspecified with cocaine-induced anxiety disorder
F14.981 Cocaine use, unspecified with cocaine-induced sexual dysfunction
F14.982 Cocaine use, unspecified with cocaine-induced sleep disorder
F14.988 Cocaine use, unspecified with other cocaine-induced disorder
F14.99 Cocaine use, unspecified with unspecified cocaine-induced disorder
F15.121 Other stimulant abuse with intoxication delirium
F15.122 Other stimulant abuse with intoxication with perceptual disturbance
F15.129 Other stimulant abuse with intoxication, unspecified
F15.13 Other stimulant abuse with withdrawal
F15.14 Other stimulant abuse with stimulant-induced mood disorder
F15.150 Other stimulant abuse with stimulant-induced psychotic disorder with delusions
F15.151 Other stimulant abuse with stimulant-induced psychotic disorder with hallucinations
F15.159 Other stimulant abuse with stimulant-induced psychotic disorder, unspecified
F15.180 Other stimulant abuse with stimulant-induced anxiety disorder
F15.181 Other stimulant abuse with stimulant-induced sexual dysfunction
F15.182 Other stimulant abuse with stimulant-induced sleep disorder
F15.188 Other stimulant abuse with other stimulant-induced disorder
F15.19 Other stimulant abuse with unspecified stimulant-induced disorder
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
F15.91 Other stimulant use, unspecified, in remission
F15.920 Other stimulant use, unspecified with intoxication, uncomplicated
F15.921 Other stimulant use, unspecified with intoxication delirium
F15.922 Other stimulant use, unspecified with intoxication with perceptual disturbance
F15.929 Other stimulant use, unspecified with intoxication, unspecified
F15.93 Other stimulant use, unspecified with withdrawal
F15.94 Other stimulant use, unspecified with stimulant-induced mood disorder
F15.950 Other stimulant use, unspecified with stimulant-induced psychotic disorder with delusions
F15.951 Other stimulant use, unspecified with stimulant-induced psychotic disorder with hallucinations
F15.959 Other stimulant use, unspecified with stimulant-induced psychotic disorder, unspecified
F15.980 Other stimulant use, unspecified with stimulant-induced anxiety disorder
F15.981 Other stimulant use, unspecified with stimulant-induced sexual dysfunction
F15.982 Other stimulant use, unspecified with stimulant-induced sleep disorder
F15.988 Other stimulant use, unspecified with other stimulant-induced disorder
F15.99 Other stimulant use, unspecified with unspecified stimulant-induced disorder
F16.121 Hallucinogen abuse with intoxication with delirium
F16.122 Hallucinogen abuse with intoxication with perceptual disturbance
F16.129 Hallucinogen abuse with intoxication, unspecified
F16.14 Hallucinogen abuse with hallucinogen-induced mood disorder
F16.150 Hallucinogen abuse with hallucinogen-induced psychotic disorder with delusions
F16.151 Hallucinogen abuse with hallucinogen-induced psychotic disorder with hallucinations
F16.159 Hallucinogen abuse with hallucinogen-induced psychotic disorder, unspecified
F16.180 Hallucinogen abuse with hallucinogen-induced anxiety disorder
F16.183 Hallucinogen abuse with hallucinogen persisting perception disorder (flashbacks)
F16.188 Hallucinogen abuse with other hallucinogen-induced disorder
F16.19 Hallucinogen abuse with unspecified hallucinogen-induced disorder
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
F16.91 Hallucinogen use, unspecified, in remission
F16.920 Hallucinogen use, unspecified with intoxication, uncomplicated
F16.921 Hallucinogen use, unspecified with intoxication with delirium
F16.929 Hallucinogen use, unspecified with intoxication, unspecified
F16.94 Hallucinogen use, unspecified with hallucinogen-induced mood disorder
F16.950 Hallucinogen use, unspecified with hallucinogen-induced psychotic disorder with delusions
F16.951 Hallucinogen use, unspecified with hallucinogen-induced psychotic disorder with hallucinations
F16.959 Hallucinogen use, unspecified with hallucinogen-induced psychotic disorder, unspecified
F16.980 Hallucinogen use, unspecified with hallucinogen-induced anxiety disorder
F16.983 Hallucinogen use, unspecified with hallucinogen persisting perception disorder (flashbacks)
F16.988 Hallucinogen use, unspecified with other hallucinogen-induced disorder
F16.99 Hallucinogen use, unspecified with unspecified hallucinogen-induced disorder
F17.203 Nicotine dependence unspecified, with withdrawal
F17.208 Nicotine dependence, unspecified, with other nicotine-induced disorders
F17.209 Nicotine dependence, unspecified, with unspecified nicotine-induced disorders
F17.213 Nicotine dependence, cigarettes, with withdrawal
F17.218 Nicotine dependence, cigarettes, with other nicotine-induced disorders
F17.219 Nicotine dependence, cigarettes, with unspecified nicotine-induced disorders
F17.223 Nicotine dependence, chewing tobacco, with withdrawal
F17.228 Nicotine dependence, chewing tobacco, with other nicotine-induced disorders
F17.229 Nicotine dependence, chewing tobacco, with unspecified nicotine-induced disorders
F17.293 Nicotine dependence, other tobacco product, with withdrawal
F17.298 Nicotine dependence, other tobacco product, with other nicotine-induced disorders
F17.299 Nicotine dependence, other tobacco product, with unspecified nicotine-induced disorders
F18.120 Inhalant abuse with intoxication, uncomplicated
F18.121 Inhalant abuse with intoxication delirium
F18.129 Inhalant abuse with intoxication, unspecified
F18.14 Inhalant abuse with inhalant-induced mood disorder
F18.150 Inhalant abuse with inhalant-induced psychotic disorder with delusions
F18.151 Inhalant abuse with inhalant-induced psychotic disorder with hallucinations
F18.159 Inhalant abuse with inhalant-induced psychotic disorder, unspecified
F18.17 Inhalant abuse with inhalant-induced dementia
F18.180 Inhalant abuse with inhalant-induced anxiety disorder
F18.188 Inhalant abuse with other inhalant-induced disorder
F18.19 Inhalant abuse with unspecified inhalant-induced disorder
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
F18.91 Inhalant use, unspecified, in remission
F18.920 Inhalant use, unspecified with intoxication, uncomplicated
F18.921 Inhalant use, unspecified with intoxication with delirium
F18.929 Inhalant use, unspecified with intoxication, unspecified
F18.94 Inhalant use, unspecified with inhalant-induced mood disorder
F18.950 Inhalant use, unspecified with inhalant-induced psychotic disorder with delusions
F18.951 Inhalant use, unspecified with inhalant-induced psychotic disorder with hallucinations
F18.959 Inhalant use, unspecified with inhalant-induced psychotic disorder, unspecified
F18.97 Inhalant use, unspecified with inhalant-induced persisting dementia
F18.980 Inhalant use, unspecified with inhalant-induced anxiety disorder
F18.988 Inhalant use, unspecified with other inhalant-induced disorder
F18.99 Inhalant use, unspecified with unspecified inhalant-induced disorder
F19.121 Other psychoactive substance abuse with intoxication delirium
F19.122 Other psychoactive substance abuse with intoxication with perceptual disturbances
F19.129 Other psychoactive substance abuse with intoxication, unspecified
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
F19.139 Other psychoactive substance abuse with withdrawal, unspecified
F19.14 Other psychoactive substance abuse with psychoactive substance-induced mood disorder
F19.150 Other psychoactive substance abuse with psychoactive substance-induced psychotic disorder with delusions
F19.151 Other psychoactive substance abuse with psychoactive substance-induced psychotic disorder with hallucinations
F19.159 Other psychoactive substance abuse with psychoactive substance-induced psychotic disorder, unspecified
F19.16 Other psychoactive substance abuse with psychoactive substance-induced persisting amnestic disorder
F19.17 Other psychoactive substance abuse with psychoactive substance-induced persisting dementia
F19.180 Other psychoactive substance abuse with psychoactive substance-induced anxiety disorder
F19.181 Other psychoactive substance abuse with psychoactive substance-induced sexual dysfunction
F19.182 Other psychoactive substance abuse with psychoactive substance-induced sleep disorder
F19.188 Other psychoactive substance abuse with other psychoactive substance-induced disorder
F19.19 Other psychoactive substance abuse with unspecified psychoactive substance-induced disorder
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
F19.91 Other psychoactive substance use, unspecified, in remission
F19.920 Other psychoactive substance use, unspecified with intoxication, uncomplicated
F19.921 Other psychoactive substance use, unspecified with intoxication with delirium
F19.922 Other psychoactive substance use, unspecified with intoxication with perceptual disturbance
F19.929 Other psychoactive substance use, unspecified with intoxication, unspecified
F19.930 Other psychoactive substance use, unspecified with withdrawal, uncomplicated
F19.931 Other psychoactive substance use, unspecified with withdrawal delirium
F19.932 Other psychoactive substance use, unspecified with withdrawal with perceptual disturbance
F19.939 Other psychoactive substance use, unspecified with withdrawal, unspecified
F19.94 Other psychoactive substance use, unspecified with psychoactive substance-induced mood disorder
F19.950 Other psychoactive substance use, unspecified with psychoactive substance-induced psychotic disorder with delusions
F19.951 Other psychoactive substance use, unspecified with psychoactive substance-induced psychotic disorder with hallucinations
F19.959 Other psychoactive substance use, unspecified with psychoactive substance-induced psychotic disorder, unspecified
F19.96 Other psychoactive substance use, unspecified with psychoactive substance-induced persisting amnestic disorder
F19.97 Other psychoactive substance use, unspecified with psychoactive substance-induced persisting dementia
F19.980 Other psychoactive substance use, unspecified with psychoactive substance-induced anxiety disorder
F19.981 Other psychoactive substance use, unspecified with psychoactive substance-induced sexual dysfunction
F19.982 Other psychoactive substance use, unspecified with psychoactive substance-induced sleep disorder
F19.988 Other psychoactive substance use, unspecified with other psychoactive substance-induced disorder
F19.99 Other psychoactive substance use, unspecified with unspecified psychoactive substance-induced disorder
F20.0 Paranoid schizophrenia
F20.1 Disorganized schizophrenia
F20.81 Schizophreniform disorder
F20.89 Other schizophrenia
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
F25.9 Schizoaffective disorder, unspecified
F28 Other psychotic disorder not due to a substance or known physiological condition
F29 Unspecified psychosis not due to a substance or known physiological condition
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
F30.8 Other manic episodes
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
F31.31 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
F31.61 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
F31.70 Bipolar disorder, currently in remission, most recent episode unspecified
F31.71 Bipolar disorder, in partial remission, most recent episode hypomanic
F31.72 Bipolar disorder, in full remission, most recent episode hypomanic
F31.73 Bipolar disorder, in partial remission, most recent episode manic
F31.75 Bipolar disorder, in partial remission, most recent episode depressed
F31.77 Bipolar disorder, in partial remission, most recent episode mixed
F31.81 Bipolar II disorder
F31.9 Bipolar disorder, unspecified
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
F32.89 Other specified depressive episodes
F32.9 Major depressive disorder, single episode, 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
F33.41 Major depressive disorder, recurrent, in partial remission
F33.8 Other recurrent depressive disorders
F34.1 Dysthymic disorder
F34.9 Persistent mood [affective] disorder, unspecified
F39 Unspecified mood [affective] disorder
F40.00 Agoraphobia, unspecified
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
F40.9 Phobic anxiety disorder, unspecified
F41.0 Panic disorder [episodic paroxysmal anxiety]
F41.1 Generalized anxiety disorder
F41.3 Other mixed anxiety disorders
F41.8 Other specified anxiety disorders
F41.9 Anxiety disorder, unspecified
F42.2 Mixed obsessional thoughts and acts
F42.4 Excoriation (skin-picking) disorder
F42.8 Other obsessive-compulsive disorder
F42.9 Obsessive-compulsive disorder, unspecified
F43.81 Prolonged grief disorder
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
F44.9 Dissociative and conversion disorder, unspecified
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
F45.8 Other somatoform disorders
F45.9 Somatoform disorder, unspecified
F48.1 Depersonalization-derealization syndrome
F48.2 Pseudobulbar affect
F48.8 Other specified nonpsychotic mental disorders
F48.9 Nonpsychotic mental disorder, unspecified
F50.82 Avoidant/restrictive food intake disorder
F53.0 Postpartum depression
F53.1 Puerperal psychosis
F68.11 Factitious disorder imposed on self, with predominantly psychological signs and symptoms
F68.13 Factitious disorder imposed on self, with combined psychological and physical signs and symptoms
F68.8 Other specified disorders of adult personality and behavior
F84.0 Autistic disorder
F84.3 Other childhood disintegrative disorder
F84.5 Asperger's syndrome
F84.8 Other pervasive developmental disorders
F99 Mental disorder, not otherwise specified
G21.0 Malignant neuroleptic syndrome
G21.11 Neuroleptic induced parkinsonism
G21.19 Other drug induced secondary parkinsonism
G21.2 Secondary parkinsonism due to other external agents
G21.3 Postencephalitic parkinsonism
G21.8 Other secondary parkinsonism
G21.9 Secondary parkinsonism, unspecified
G24.01 Drug induced subacute dyskinesia
G24.02 Drug induced acute dystonia
G25.70 Drug induced movement disorder, unspecified
G25.71 Drug induced akathisia
G25.79 Other drug induced movement disorders
G25.81 Restless legs syndrome
G25.89 Other specified extrapyramidal and movement disorders
G25.9 Extrapyramidal and movement disorder, unspecified
G26 Extrapyramidal and movement disorders in diseases classified elsewhere
G31.01 Pick's disease
G31.09 Other frontotemporal neurocognitive disorder
G31.1 Senile degeneration of brain, not elsewhere classified
G31.83 Neurocognitive disorder with Lewy bodies
G31.85 Corticobasal degeneration
G80.3 Athetoid cerebral palsy
R44.0 Auditory hallucinations
R44.2 Other hallucinations
R44.3 Hallucinations, unspecified
R45.5 Hostility
R45.6 Violent behavior
R56.1 Post traumatic seizures
T43.641A Poisoning by ecstasy, accidental (unintentional), initial encounter
T43.641D Poisoning by ecstasy, accidental (unintentional), subsequent encounter
T43.641S Poisoning by ecstasy, accidental (unintentional), sequela
T43.642A Poisoning by ecstasy, intentional self-harm, initial encounter
T43.642D Poisoning by ecstasy, intentional self-harm, subsequent encounter
T43.642S Poisoning by ecstasy, intentional self-harm, sequela
T43.643A Poisoning by ecstasy, assault, initial encounter
T43.643D Poisoning by ecstasy, assault, subsequent encounter
T43.643S Poisoning by ecstasy, assault, sequela
T43.644A Poisoning by ecstasy, undetermined, initial encounter
T43.644D Poisoning by ecstasy, undetermined, subsequent encounter
T43.644S Poisoning by ecstasy, undetermined, sequela
T43.651A Poisoning by methamphetamines accidental (unintentional), initial encounter
T43.651D Poisoning by methamphetamines accidental (unintentional), subsequent encounter
T43.651S Poisoning by methamphetamines accidental (unintentional), sequela
T43.652A Poisoning by methamphetamines intentional self-harm, initial encounter
T43.652D Poisoning by methamphetamines intentional self-harm, subsequent encounter
T43.652S Poisoning by methamphetamines intentional self-harm, sequela
T43.653A Poisoning by methamphetamines, assault, initial encounter
T43.653D Poisoning by methamphetamines, assault, subsequent encounter
T43.653S Poisoning by methamphetamines, assault, sequela
T43.654A Poisoning by methamphetamines, undetermined, initial encounter
T43.654D Poisoning by methamphetamines, undetermined, subsequent encounter
T43.654S Poisoning by methamphetamines, undetermined, sequela
T43.655A Adverse effect of methamphetamines, initial encounter
T43.655D Adverse effect of methamphetamines, subsequent encounter
T43.655S Adverse effect of methamphetamines, sequela
T43.656A Underdosing of methamphetamines, initial encounter
T43.656D Underdosing of methamphetamines, subsequent encounter
T43.656S Underdosing of methamphetamines, sequela
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ICD-10-CM Codes that DO NOT Support Medical Necessity

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ICD-10-PCS 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

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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

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Other Coding Information

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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
11/09/2023 R6

Under CMS National Coverage Policy updated section headings for regulations. The following regulations were added: “Title XVIII of the Social Security Act, §1833(e) prohibits Medicare payment for any claim lacking the necessary documentation to process the claim.” and “CMS Internet-Only Manual, Pub. 100-08, Medicare Program Integrity Manual, Chapter 6, §6.2.4 Coding and §6.2.7 Medical review of Home Health Demand Bills”.

10/01/2022 R5

Under ICD-10-CM Codes that Support Medical Necessity Group 1: Codes deleted F01.51, F02.81, F03.91 and added F03.911, F03.918, F03.92, F03.93, F03.94, F10.90, F10.91, F11.91, F12.91, F13.91, F14.91, F15.91, F16.91, F18.91, F19.91, T43.651A, T43.651D, T43.651S, T43.652A, T43.652D, T43.652S, T43.653A, T43.653D, T43.653S, T43.654A, T43.654D, T43.654S, T43.655A, T43.655D, T43.655S, T43.656A, T43.656D, T43.656S, F03.A0, F03.A11, F03.A18, F03.A2, F03.A3, F03.A4, F03.B11, F03.B18, F03.B2, F03.B3, F03.B4, F03.C11, F03.C18, F03.C2, F03.C3, F03.C4, F06.71, F43.81. Code descriptions were revised for F03.90, G31.09, and G31.83. This revision is due to the Annual ICD-10-CM Update and will become effective on 10/1/22.

10/01/2020 R4

Under ICD-10 Codes that Support Medical Necessity Group1: Codes added F10.130, F10.131, F10.132, F10.139, F10.930, F10.931, F10.932, F10.939, F11.13, F12.13, F13.130, F13.131, F13.132, F13.139, F14.13, F14.93, F15.13, F19.130, F19.131, F19.132, F19.139. This revision is due to the Annual ICD-10 Updates and is effective on 10/1/2020.

10/10/2019 R3

This article is being revised in order to adhere to CMS requirements per Chapter 13, Section 13.5.1 of the Program Integrity Manual, to remove all coding from LCDs and incorporate into related Billing and Coding Articles. CMS Internet-Only Manual, Pub. 100-04, Medicare Claims Processing Manual, Chapter 10, §40.2 was removed from the CMS National Coverage Policy section of the related Home Health - Psychiatric Care L34561 LCD and placed in this article.

08/01/2019 R2

ICD-10 code F44.1 was added to the Covered ICD-10 Codes Group 1: Codes as it was inadvertently left off.

08/01/2019 R1

All coding located in the Coding Information section has been removed from the related Home Health – Psychiatric Care L34561 LCD and added to this article.

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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
LCDs
L34561 - Home Health - Psychiatric Care
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
11/03/2023 11/09/2023 - N/A Currently in Effect You are here
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Keywords

  • Home Health
  • Psychiatric Care