Does F78.A9 require prior authorization?

No, F78.A9 does not require prior authorization (medium confidence). Covered without prior authorization by at least one policy, though another does not cover it.

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`F78.A9`, Other genetic related intellectual disability

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization by at least one policy, though another does not cover it (medium confidence)

Documentation Required

Medical record must contain documentation supporting medical necessity, including relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.
Each claim must be submitted with ICD-10-CM diagnosis code(s) that describe the patient's condition and reasons for the service; claims without a valid ICD-10-CM code will be returned as incomplete.
For services requiring a referring/ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim.

Key Coverage Criteria

Patient has an underlying physical illness or injury for which the HBAI service is intended.
There is documentation that biopsychosocial factors are significantly affecting treatment or medical management of the illness or injury.
Patient is alert, oriented, and has capacity to understand and respond meaningfully during a face-to-face encounter.
There is a documented need for psychological evaluation or intervention to successfully manage the patient's physical illness and activities of daily living.
The HBAI assessment is not duplicative of other provider assessments.
Reassessment is reasonable only when documentation shows a sufficient change in mental or medical status warranting re-evaluation of the patient's capacity to understand and cooperate with medical interventions.

20 Active Policies

CGS-J15-L34196, Psychiatric Partial Hospitalization Programs

J15

CGS-J15-L34183, Psychiatric Inpatient Hospitalization

J15

CGS-J18-L34196, Psychiatric Partial Hospitalization Programs

J18

CGS-J18-L34183, Psychiatric Inpatient Hospitalization

J18

A56865, Billing and Coding: Psychiatric Inpatient Hospitalization

A52434, Health and Behavior Assessment/Intervention Medical Policy Article

A57780, Billing and Coding: Psychological and Neuropsychological Tests

FIRST_COAST-L34520, Psychological and Neuropsychological Tests

NOVITAS-JH-L35007, Vestibular and Audiologic Function Studies

NOVITAS-JH-L35049, Monitored Anesthesia Care

NOVITAS-JH-L35101, Psychiatric Codes

NOVITAS-JL-L35007, Vestibular and Audiologic Function Studies

NOVITAS-JL-L35101, Psychiatric Codes

NOVITAS-JL-L35049, Monitored Anesthesia Care

A57130, Billing and Coding: Psychiatric Codes

A57361, Billing and Coding: Monitored Anesthesia Care

A57434, Billing and Coding: Vestibular and Audiologic Function Studies

A57204, Billing and Coding: MRI and CT Scans of the Head and Neck

A57052, Billing and Coding: Psychiatric Inpatient Hospitalization

A57053, Billing and Coding: Psychiatric Partial Hospitalization Programs

`F78.A9`, Other genetic related intellectual disability

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

F78.A9, Other genetic related intellectual disability

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`F78.A9`, Other genetic related intellectual disability