Policy source
The recorded policy does not contain a public text excerpt. Read the official source for details.
Codes in this policy
Code numbers and each code’s status as the policy records it. CPT code descriptions are left out of this page, as are the passages that cite CPT codes; the official document has them.
| Code | Code system | Status in this policy |
|---|---|---|
| 90785 | HCPCS | Covered |
| 90791 | HCPCS | Covered |
| 90792 | HCPCS | Covered |
| 90832 | HCPCS | Covered |
| 90833 | HCPCS | Covered |
| 90834 | HCPCS | Covered |
| 90836 | HCPCS | Covered |
| 90837 | HCPCS | Covered |
| 90838 | HCPCS | Covered |
| 90839 | HCPCS | Covered |
| 90840 | HCPCS | Covered |
| 90845 | HCPCS | Covered |
| 90846 | HCPCS | Covered |
| 90847 | HCPCS | Covered |
| 90853 | HCPCS | Covered |
| G0017 | HCPCS | Covered |
| G0018 | HCPCS | Covered |
| G0560 | HCPCS | Covered |
| F01.511 | ICD10CM | Covered |
| F01.518 | ICD10CM | Covered |
| F01.52 | ICD10CM | Covered |
| F01.53 | ICD10CM | Covered |
| F01.54 | ICD10CM | Covered |
| F01.A0 | ICD10CM | Covered |
| F01.A11 | ICD10CM | Covered |
| F01.A18 | ICD10CM | Covered |
| F01.A2 | ICD10CM | Covered |
| F01.A3 | ICD10CM | Covered |
| F01.A4 | ICD10CM | Covered |
| F01.B0 | ICD10CM | Covered |
| F01.B11 | ICD10CM | Covered |
| F01.B18 | ICD10CM | Covered |
| F01.B2 | ICD10CM | Covered |
| F01.B3 | ICD10CM | Covered |
| F01.B4 | ICD10CM | Covered |
| F01.C0 | ICD10CM | Covered |
| F01.C11 | ICD10CM | Covered |
| F01.C18 | ICD10CM | Covered |
| F01.C2 | ICD10CM | Covered |
| F01.C3 | ICD10CM | Covered |
| F01.C4 | ICD10CM | Covered |
| F02.80 | ICD10CM | Covered |
| F02.811 | ICD10CM | Covered |
| F02.818 | ICD10CM | Covered |
| F02.82 | ICD10CM | Covered |
| F02.83 | ICD10CM | Covered |
| F02.84 | ICD10CM | Covered |
| F02.A0 | ICD10CM | Covered |
| F02.A11 | ICD10CM | Covered |
| F02.A18 | ICD10CM | Covered |
| F02.A2 | ICD10CM | Covered |
| F02.A3 | ICD10CM | Covered |
| F02.A4 | ICD10CM | Covered |
| F02.B0 | ICD10CM | Covered |
| F02.B11 | ICD10CM | Covered |
| F02.B18 | ICD10CM | Covered |
| F02.B2 | ICD10CM | Covered |
| F02.B3 | ICD10CM | Covered |
| F02.B4 | ICD10CM | Covered |
| F02.C0 | ICD10CM | Covered |
| F02.C11 | ICD10CM | Covered |
| F02.C18 | ICD10CM | Covered |
| F02.C2 | ICD10CM | Covered |
| F02.C3 | ICD10CM | Covered |
| F02.C4 | ICD10CM | Covered |
| F03.90 | ICD10CM | Covered |
| F03.911 | ICD10CM | Covered |
| F03.918 | ICD10CM | Covered |
| F03.92 | ICD10CM | Covered |
| F03.93 | ICD10CM | Covered |
| F03.94 | ICD10CM | Covered |
| F03.A0 | ICD10CM | Covered |
| F03.A11 | ICD10CM | Covered |
| F03.A18 | ICD10CM | Covered |
| F03.A2 | ICD10CM | Covered |
| F03.A3 | ICD10CM | Covered |
| F03.A4 | ICD10CM | Covered |
| F03.B0 | ICD10CM | Covered |
| F03.B11 | ICD10CM | Covered |
| F03.B18 | ICD10CM | Covered |
| F03.B2 | ICD10CM | Covered |
| F03.B3 | ICD10CM | Covered |
| F03.B4 | ICD10CM | Covered |
| F03.C0 | ICD10CM | Covered |
| F03.C11 | ICD10CM | Covered |
| F03.C18 | ICD10CM | Covered |
| F03.C2 | ICD10CM | Covered |
| F03.C3 | ICD10CM | Covered |
| F03.C4 | ICD10CM | Covered |
| F04 | ICD10CM | Covered |
| F05 | ICD10CM | Covered |
| F06.0 | ICD10CM | Covered |
| F06.1 | ICD10CM | Covered |
| F06.30 | ICD10CM | Covered |
| F06.31 | ICD10CM | Covered |
| F06.32 | ICD10CM | Covered |
| F06.33 | ICD10CM | Covered |
| F06.34 | ICD10CM | Covered |
| F06.4 | ICD10CM | Covered |
| F06.8 | ICD10CM | Covered |
| F07.0 | ICD10CM | Covered |
| F07.81 | ICD10CM | Covered |
| F07.89 | ICD10CM | Covered |
| F07.9 | ICD10CM | Covered |
| F09 | ICD10CM | Covered |
| F10.10 | ICD10CM | Covered |
| F10.11 | ICD10CM | Covered |
| F10.120 | ICD10CM | Covered |
| F10.121 | ICD10CM | Covered |
| F10.129 | ICD10CM | Covered |
| F10.130 | ICD10CM | Covered |
| F10.131 | ICD10CM | Covered |
| F10.132 | ICD10CM | Covered |
| F10.14 | ICD10CM | Covered |
| F10.150 | ICD10CM | Covered |
| F10.151 | ICD10CM | Covered |
| F10.159 | ICD10CM | Covered |
| F10.180 | ICD10CM | Covered |
| F10.181 | ICD10CM | Covered |
| F10.182 | ICD10CM | Covered |
| F10.188 | ICD10CM | Covered |
| F10.19 | ICD10CM | Covered |
| F10.20 | ICD10CM | Covered |
| F10.21 | ICD10CM | Covered |
| F10.220 | ICD10CM | Covered |
| F10.221 | ICD10CM | Covered |
| F10.229 | ICD10CM | Covered |
| F10.930 | ICD10CM | Covered |
| F10.931 | ICD10CM | Covered |
| F10.932 | ICD10CM | Covered |
| F11.10 | ICD10CM | Covered |
| F11.11 | ICD10CM | Covered |
| F11.120 | ICD10CM | Covered |
| F11.129 | ICD10CM | Covered |
| F11.13 | ICD10CM | Covered |
| F11.20 | ICD10CM | Covered |
| F11.21 | ICD10CM | Covered |
| F11.220 | ICD10CM | Covered |
| F11.221 | ICD10CM | Covered |
| F11.222 | ICD10CM | Covered |
| F11.229 | ICD10CM | Covered |
| F11.23 | ICD10CM | Covered |
| F11.24 | ICD10CM | Covered |
| F11.250 | ICD10CM | Covered |
| F11.251 | ICD10CM | Covered |
| F11.259 | ICD10CM | Covered |
| F11.281 | ICD10CM | Covered |
| F11.282 | ICD10CM | Covered |
| F11.288 | ICD10CM | Covered |
| F11.29 | ICD10CM | Covered |
| F11.90 | ICD10CM | Covered |
| F11.91 | ICD10CM | Covered |
| F12.10 | ICD10CM | Covered |
| F12.11 | ICD10CM | Covered |
| F12.13 | ICD10CM | Covered |
| F12.20 | ICD10CM | Covered |
| F12.21 | ICD10CM | Covered |
| F12.220 | ICD10CM | Covered |
| F12.221 | ICD10CM | Covered |
| F12.222 | ICD10CM | Covered |
| F12.229 | ICD10CM | Covered |
| F12.23 | ICD10CM | Covered |
| F12.250 | ICD10CM | Covered |
| F12.251 | ICD10CM | Covered |
| F12.259 | ICD10CM | Covered |
| F12.280 | ICD10CM | Covered |
| F12.288 | ICD10CM | Covered |
| F12.29 | ICD10CM | Covered |
| F12.90 | ICD10CM | Covered |
| F12.91 | ICD10CM | Covered |
| F12.93 | ICD10CM | Covered |
| F13.10 | ICD10CM | Covered |
| F13.11 | ICD10CM | Covered |
| F13.120 | ICD10CM | Covered |
| F13.130 | ICD10CM | Covered |
| F13.131 | ICD10CM | Covered |
| F13.132 | ICD10CM | Covered |
| F13.20 | ICD10CM | Covered |
| F13.21 | ICD10CM | Covered |
| F13.220 | ICD10CM | Covered |
| F13.221 | ICD10CM | Covered |
| F13.229 | ICD10CM | Covered |
| F13.230 | ICD10CM | Covered |
| F13.231 | ICD10CM | Covered |
| F13.232 | ICD10CM | Covered |
| F13.239 | ICD10CM | Covered |
| F13.24 | ICD10CM | Covered |
| F13.250 | ICD10CM | Covered |
| F13.251 | ICD10CM | Covered |
| F13.259 | ICD10CM | Covered |
| F13.26 | ICD10CM | Covered |
| F13.27 | ICD10CM | Covered |
| F13.280 | ICD10CM | Covered |
| F13.281 | ICD10CM | Covered |
| F13.282 | ICD10CM | Covered |
| F13.288 | ICD10CM | Covered |
| F13.29 | ICD10CM | Covered |
| F13.90 | ICD10CM | Covered |
| F13.91 | ICD10CM | Covered |
| F14.10 | ICD10CM | Covered |
| F14.11 | ICD10CM | Covered |
| F14.120 | ICD10CM | Covered |
| F14.13 | ICD10CM | Covered |
| F14.20 | ICD10CM | Covered |
| F14.21 | ICD10CM | Covered |
| F14.220 | ICD10CM | Covered |
| F14.221 | ICD10CM | Covered |
| F14.222 | ICD10CM | Covered |
| F14.229 | ICD10CM | Covered |
| F14.23 | ICD10CM | Covered |
| F14.24 | ICD10CM | Covered |
| F14.250 | ICD10CM | Covered |
| F14.251 | ICD10CM | Covered |
| F14.259 | ICD10CM | Covered |
| F14.280 | ICD10CM | Covered |
| F14.281 | ICD10CM | Covered |
| F14.282 | ICD10CM | Covered |
| F14.288 | ICD10CM | Covered |
| F14.29 | ICD10CM | Covered |
| F14.90 | ICD10CM | Covered |
| F14.91 | ICD10CM | Covered |
| F14.93 | ICD10CM | Covered |
| F15.10 | ICD10CM | Covered |
| F15.11 | ICD10CM | Covered |
| F15.120 | ICD10CM | Covered |
| F15.13 | ICD10CM | Covered |
| F15.20 | ICD10CM | Covered |
| F15.21 | ICD10CM | Covered |
| F15.220 | ICD10CM | Covered |
| F15.221 | ICD10CM | Covered |
| F15.222 | ICD10CM | Covered |
| F15.229 | ICD10CM | Covered |
| F15.23 | ICD10CM | Covered |
| F15.24 | ICD10CM | Covered |
| F15.250 | ICD10CM | Covered |
| F15.251 | ICD10CM | Covered |
| F15.259 | ICD10CM | Covered |
| F15.280 | ICD10CM | Covered |
| F15.281 | ICD10CM | Covered |
| F15.282 | ICD10CM | Covered |
| F15.288 | ICD10CM | Covered |
| F15.29 | ICD10CM | Covered |
| F15.90 | ICD10CM | Covered |
| F15.91 | ICD10CM | Covered |
| F16.10 | ICD10CM | Covered |
| F16.11 | ICD10CM | Covered |
| F16.120 | ICD10CM | Covered |
| F16.20 | ICD10CM | Covered |
| F16.21 | ICD10CM | Covered |
| F16.220 | ICD10CM | Covered |
| F16.221 | ICD10CM | Covered |
| F16.229 | ICD10CM | Covered |
| F16.24 | ICD10CM | Covered |
| F16.250 | ICD10CM | Covered |
| F16.251 | ICD10CM | Covered |
| F16.259 | ICD10CM | Covered |
| F16.280 | ICD10CM | Covered |
| F16.283 | ICD10CM | Covered |
| F16.288 | ICD10CM | Covered |
| F16.29 | ICD10CM | Covered |
| F16.90 | ICD10CM | Covered |
| F16.91 | ICD10CM | Covered |
| F17.200 | ICD10CM | Covered |
| F17.201 | ICD10CM | Covered |
| F17.210 | ICD10CM | Covered |
| F17.211 | ICD10CM | Covered |
| F17.220 | ICD10CM | Covered |
| F17.221 | ICD10CM | Covered |
| F17.290 | ICD10CM | Covered |
| F17.291 | ICD10CM | Covered |
| F18.10 | ICD10CM | Covered |
| F18.11 | ICD10CM | Covered |
| F18.120 | ICD10CM | Covered |
| F18.20 | ICD10CM | Covered |
| F18.21 | ICD10CM | Covered |
| F18.220 | ICD10CM | Covered |
| F18.221 | ICD10CM | Covered |
| F18.229 | ICD10CM | Covered |
| F18.24 | ICD10CM | Covered |
| F18.250 | ICD10CM | Covered |
| F18.251 | ICD10CM | Covered |
| F18.259 | ICD10CM | Covered |
| F18.27 | ICD10CM | Covered |
| F18.280 | ICD10CM | Covered |
| F18.288 | ICD10CM | Covered |
| F18.29 | ICD10CM | Covered |
| F18.90 | ICD10CM | Covered |
| F18.91 | ICD10CM | Covered |
| F19.10 | ICD10CM | Covered |
| F19.11 | ICD10CM | Covered |
| F19.120 | ICD10CM | Covered |
| F19.130 | ICD10CM | Covered |
| F19.131 | ICD10CM | Covered |
| F19.132 | ICD10CM | Covered |
| F19.20 | ICD10CM | Covered |
| F19.21 | ICD10CM | Covered |
| F19.220 | ICD10CM | Covered |
| F19.221 | ICD10CM | Covered |
| F19.222 | ICD10CM | Covered |
| F19.229 | ICD10CM | Covered |
| F19.230 | ICD10CM | Covered |
| F19.231 | ICD10CM | Covered |
| F19.232 | ICD10CM | Covered |
| F19.239 | ICD10CM | Covered |
| F19.24 | ICD10CM | Covered |
| F19.250 | ICD10CM | Covered |
| F19.251 | ICD10CM | Covered |
| F19.259 | ICD10CM | Covered |
| F19.26 | ICD10CM | Covered |
| F19.27 | ICD10CM | Covered |
| F19.280 | ICD10CM | Covered |
| F19.281 | ICD10CM | Covered |
| F19.282 | ICD10CM | Covered |
| F19.288 | ICD10CM | Covered |
| F19.29 | ICD10CM | Covered |
| F19.90 | ICD10CM | Covered |
| F19.91 | ICD10CM | Covered |
| F20.0 | ICD10CM | Covered |
| F20.1 | ICD10CM | Covered |
| F20.2 | ICD10CM | Covered |
| F20.3 | ICD10CM | Covered |
| F20.5 | ICD10CM | Covered |
| F20.81 | ICD10CM | Covered |
| F20.89 | ICD10CM | Covered |
| F21 | ICD10CM | Covered |
| F22 | ICD10CM | Covered |
| F23 | ICD10CM | Covered |
| F24 | ICD10CM | Covered |
| F25.0 | ICD10CM | Covered |
| F25.1 | ICD10CM | Covered |
| F25.8 | ICD10CM | Covered |
| F30.10 | ICD10CM | Covered |
| F30.11 | ICD10CM | Covered |
| F30.12 | ICD10CM | Covered |
| F30.13 | ICD10CM | Covered |
| F30.2 | ICD10CM | Covered |
| F30.3 | ICD10CM | Covered |
| F30.4 | ICD10CM | Covered |
| F30.8 | ICD10CM | Covered |
| F31.0 | ICD10CM | Covered |
| F31.10 | ICD10CM | Covered |
| F31.11 | ICD10CM | Covered |
| F31.12 | ICD10CM | Covered |
| F31.13 | ICD10CM | Covered |
| F31.2 | ICD10CM | Covered |
| F31.30 | ICD10CM | Covered |
| F31.31 | ICD10CM | Covered |
| F31.32 | ICD10CM | Covered |
| F31.4 | ICD10CM | Covered |
| F31.5 | ICD10CM | Covered |
| F31.60 | ICD10CM | Covered |
| F31.61 | ICD10CM | Covered |
| F31.62 | ICD10CM | Covered |
| F31.63 | ICD10CM | Covered |
| F31.64 | ICD10CM | Covered |
| F31.81 | ICD10CM | Covered |
| F31.89 | ICD10CM | Covered |
| F32.0 | ICD10CM | Covered |
| F32.1 | ICD10CM | Covered |
| F32.2 | ICD10CM | Covered |
| F32.3 | ICD10CM | Covered |
| F32.4 | ICD10CM | Covered |
| F32.5 | ICD10CM | Covered |
| F32.81 | ICD10CM | Covered |
| F32.89 | ICD10CM | Covered |
| F32.A | ICD10CM | Covered |
| F33.0 | ICD10CM | Covered |
| F33.1 | ICD10CM | Covered |
| F33.2 | ICD10CM | Covered |
| F33.3 | ICD10CM | Covered |
| F33.40 | ICD10CM | Covered |
| F33.41 | ICD10CM | Covered |
| F33.42 | ICD10CM | Covered |
| F33.8 | ICD10CM | Covered |
| F34.0 | ICD10CM | Covered |
| F34.1 | ICD10CM | Covered |
| F34.81 | ICD10CM | Covered |
| F34.89 | ICD10CM | Covered |
| F40.01 | ICD10CM | Covered |
| F40.02 | ICD10CM | Covered |
| F40.10 | ICD10CM | Covered |
| F40.11 | ICD10CM | Covered |
| F40.210 | ICD10CM | Covered |
| F40.218 | ICD10CM | Covered |
| F40.220 | ICD10CM | Covered |
| F40.228 | ICD10CM | Covered |
| F40.230 | ICD10CM | Covered |
| F40.231 | ICD10CM | Covered |
| F40.232 | ICD10CM | Covered |
| F40.233 | ICD10CM | Covered |
| F40.240 | ICD10CM | Covered |
| F40.241 | ICD10CM | Covered |
| F40.242 | ICD10CM | Covered |
| F40.243 | ICD10CM | Covered |
| F40.248 | ICD10CM | Covered |
| F40.290 | ICD10CM | Covered |
| F40.291 | ICD10CM | Covered |
| F40.298 | ICD10CM | Covered |
| F40.8 | ICD10CM | Covered |
| F41.0 | ICD10CM | Covered |
| F41.1 | ICD10CM | Covered |
| F41.3 | ICD10CM | Covered |
| F41.8 | ICD10CM | Covered |
| F42.2 | ICD10CM | Covered |
| F42.3 | ICD10CM | Covered |
| F42.4 | ICD10CM | Covered |
| F42.8 | ICD10CM | Covered |
| F42.9 | ICD10CM | Covered |
| F43.0 | ICD10CM | Covered |
| F43.10 | ICD10CM | Covered |
| F43.11 | ICD10CM | Covered |
| F43.12 | ICD10CM | Covered |
| F43.20 | ICD10CM | Covered |
| F43.21 | ICD10CM | Covered |
| F43.22 | ICD10CM | Covered |
| F43.23 | ICD10CM | Covered |
| F43.24 | ICD10CM | Covered |
| F43.25 | ICD10CM | Covered |
| F43.29 | ICD10CM | Covered |
| F43.89 | ICD10CM | Covered |
| F44.0 | ICD10CM | Covered |
| F44.1 | ICD10CM | Covered |
| F44.2 | ICD10CM | Covered |
| F44.4 | ICD10CM | Covered |
| F44.5 | ICD10CM | Covered |
| F44.6 | ICD10CM | Covered |
| F44.7 | ICD10CM | Covered |
| F44.81 | ICD10CM | Covered |
| F44.89 | ICD10CM | Covered |
| F45.0 | ICD10CM | Covered |
| F45.1 | ICD10CM | Covered |
| F45.20 | ICD10CM | Covered |
| F45.21 | ICD10CM | Covered |
| F45.22 | ICD10CM | Covered |
| F45.29 | ICD10CM | Covered |
| F45.41 | ICD10CM | Covered |
| F45.42 | ICD10CM | Covered |
| F45.8 | ICD10CM | Covered |
| F48.1 | ICD10CM | Covered |
| F48.2 | ICD10CM | Covered |
| F48.8 | ICD10CM | Covered |
| F50.00 | ICD10CM | Covered |
| F50.010 | ICD10CM | Covered |
| F50.011 | ICD10CM | Covered |
| F50.012 | ICD10CM | Covered |
| F50.013 | ICD10CM | Covered |
| F50.014 | ICD10CM | Covered |
| F50.020 | ICD10CM | Covered |
| F50.021 | ICD10CM | Covered |
| F50.022 | ICD10CM | Covered |
| F50.023 | ICD10CM | Covered |
| F50.024 | ICD10CM | Covered |
| F50.21 | ICD10CM | Covered |
| F50.22 | ICD10CM | Covered |
| F50.23 | ICD10CM | Covered |
| F50.24 | ICD10CM | Covered |
| F50.25 | ICD10CM | Covered |
| F50.810 | ICD10CM | Covered |
| F50.811 | ICD10CM | Covered |
| F50.812 | ICD10CM | Covered |
| F50.813 | ICD10CM | Covered |
| F50.814 | ICD10CM | Covered |
| F50.82 | ICD10CM | Covered |
| F50.83 | ICD10CM | Covered |
| F50.89 | ICD10CM | Covered |
| F51.01 | ICD10CM | Covered |
| F51.02 | ICD10CM | Covered |
| F51.03 | ICD10CM | Covered |
| F51.04 | ICD10CM | Covered |
| F51.05 | ICD10CM | Covered |
| F51.09 | ICD10CM | Covered |
| F51.11 | ICD10CM | Covered |
| F51.12 | ICD10CM | Covered |
| F51.13 | ICD10CM | Covered |
| F51.19 | ICD10CM | Covered |
| F51.3 | ICD10CM | Covered |
| F51.4 | ICD10CM | Covered |
| F51.5 | ICD10CM | Covered |
| F51.8 | ICD10CM | Covered |
| F52.0 | ICD10CM | Covered |
| F52.1 | ICD10CM | Covered |
| F52.21 | ICD10CM | Covered |
| F52.22 | ICD10CM | Covered |
| F52.31 | ICD10CM | Covered |
| F52.32 | ICD10CM | Covered |
| F52.4 | ICD10CM | Covered |
| F52.5 | ICD10CM | Covered |
| F52.6 | ICD10CM | Covered |
| F52.8 | ICD10CM | Covered |
| F53.0 | ICD10CM | Covered |
| F53.1 | ICD10CM | Covered |
| F54 | ICD10CM | Covered |
| F55.0 | ICD10CM | Covered |
| F55.1 | ICD10CM | Covered |
| F55.2 | ICD10CM | Covered |
| F55.3 | ICD10CM | Covered |
| F55.4 | ICD10CM | Covered |
| F55.8 | ICD10CM | Covered |
| F59 | ICD10CM | Covered |
| F60.0 | ICD10CM | Covered |
| F60.1 | ICD10CM | Covered |
| F60.2 | ICD10CM | Covered |
| F60.3 | ICD10CM | Covered |
| F60.4 | ICD10CM | Covered |
| F60.5 | ICD10CM | Covered |
| F60.6 | ICD10CM | Covered |
| F60.7 | ICD10CM | Covered |
| F60.81 | ICD10CM | Covered |
| F60.89 | ICD10CM | Covered |
| F60.9 | ICD10CM | Covered |
| F63.0 | ICD10CM | Covered |
| F63.1 | ICD10CM | Covered |
| F63.2 | ICD10CM | Covered |
| F63.3 | ICD10CM | Covered |
| F63.81 | ICD10CM | Covered |
| F63.89 | ICD10CM | Covered |
| F63.9 | ICD10CM | Covered |
| F64.0 | ICD10CM | Covered |
| F64.1 | ICD10CM | Covered |
| F64.2 | ICD10CM | Covered |
| F64.8 | ICD10CM | Covered |
| F64.9 | ICD10CM | Covered |
| F65.0 | ICD10CM | Covered |
| F65.1 | ICD10CM | Covered |
| F65.2 | ICD10CM | Covered |
| F65.3 | ICD10CM | Covered |
| F65.4 | ICD10CM | Covered |
| F65.50 | ICD10CM | Covered |
| F65.51 | ICD10CM | Covered |
| F65.52 | ICD10CM | Covered |
| F65.81 | ICD10CM | Covered |
| F65.89 | ICD10CM | Covered |
| F65.9 | ICD10CM | Covered |
| F66 | ICD10CM | Covered |
| F68.10 | ICD10CM | Covered |
| F68.11 | ICD10CM | Covered |
| F68.12 | ICD10CM | Covered |
| F68.13 | ICD10CM | Covered |
| F68.8 | ICD10CM | Covered |
| F68.A | ICD10CM | Covered |
| F69 | ICD10CM | Covered |
| F70 | ICD10CM | Covered |
| F71 | ICD10CM | Covered |
| F72 | ICD10CM | Covered |
| F73 | ICD10CM | Covered |
| F80.0 | ICD10CM | Covered |
| F80.1 | ICD10CM | Covered |
| F80.2 | ICD10CM | Covered |
| F80.4 | ICD10CM | Covered |
| F80.81 | ICD10CM | Covered |
| F80.82 | ICD10CM | Covered |
| F80.89 | ICD10CM | Covered |
| F80.9 | ICD10CM | Covered |
| F81.0 | ICD10CM | Covered |
| F81.2 | ICD10CM | Covered |
| F81.81 | ICD10CM | Covered |
| F81.89 | ICD10CM | Covered |
| F81.9 | ICD10CM | Covered |
| F82 | ICD10CM | Covered |
| F88 | ICD10CM | Covered |
| F89 | ICD10CM | Covered |
| F90.0 | ICD10CM | Covered |
| F90.1 | ICD10CM | Covered |
| F90.2 | ICD10CM | Covered |
| F90.8 | ICD10CM | Covered |
| F90.9 | ICD10CM | Covered |
| F91.0 | ICD10CM | Covered |
| F91.1 | ICD10CM | Covered |
| F91.2 | ICD10CM | Covered |
| F91.3 | ICD10CM | Covered |
| F91.8 | ICD10CM | Covered |
| F91.9 | ICD10CM | Covered |
| F93.0 | ICD10CM | Covered |
| F93.8 | ICD10CM | Covered |
| F93.9 | ICD10CM | Covered |
| F94.0 | ICD10CM | Covered |
| F94.1 | ICD10CM | Covered |
| F94.2 | ICD10CM | Covered |
| F94.8 | ICD10CM | Covered |
| F94.9 | ICD10CM | Covered |
| F95.0 | ICD10CM | Covered |
| F95.1 | ICD10CM | Covered |
| F95.2 | ICD10CM | Covered |
| F95.8 | ICD10CM | Covered |
| F95.9 | ICD10CM | Covered |
| F98.0 | ICD10CM | Covered |
| F98.1 | ICD10CM | Covered |
| F98.21 | ICD10CM | Covered |
| F98.29 | ICD10CM | Covered |
| F98.3 | ICD10CM | Covered |
| F98.4 | ICD10CM | Covered |
| F98.5 | ICD10CM | Covered |
| F98.8 | ICD10CM | Covered |
| F98.9 | ICD10CM | Covered |
| F99 | ICD10CM | Covered |
| G30.0 | ICD10CM | Covered |
| G30.1 | ICD10CM | Covered |
| G30.8 | ICD10CM | Covered |
| G30.9 | ICD10CM | Covered |
| Z01.818 | ICD10CM | Covered |