Does F21 require prior authorization?

No, F21 does not require prior authorization (low confidence). No active coverage policies found for this code.

`F21`, Schizotypal disorder

ICD-10-CM

No Prior Auth Required

No active coverage policies found for this code (low confidence)

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.
If initial assessment or reassessment is completed over multiple encounters, the date of service should be the date the interview was finalized on the claim.
Advance Beneficiary Notice (ABN) may be used for services likely to be non-covered for medical necessity or other reasons per CMS guidance.
For physicians, clinical nurse specialists, or nurse practitioners performing these services, use Evaluation & Management or Preventive Medicine codes; services for evaluation/treatment of mental illness should be coded with psychiatric CPT codes (90791-90899) and when both psychiatric and HBAI services are provided, report the predominant service.

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.

CGS-J15-L34353, Outpatient Psychiatry and Psychology Services

J15

CGS-J18-L34353, Outpatient Psychiatry and Psychology Services

J18

NGS-J6-L33632, Psychiatry and Psychology Services

A56937, Billing and Coding: Psychiatry and Psychology Services

Ask Verity about documentation requirements, denial risks, or coverage in your state.