F51.04 — Psychophysiologic insomnia
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- This article provides billing/coding guidelines that complement Local Coverage Determination L34417 for CT of the head; consult LCD L34417 for specific coverage, coding, and documentation requirements.
- All documentation must be maintained in the patient's medical record, be legible, include patient identification and dates of service, and be available to the contractor upon request.
- The record must identify the physician or non-physician practitioner responsible for and providing the care to the patient.
- The submitted medical record must support the selected diagnosis code(s) and the submitted CPT/HCPCS code must accurately describe the service performed.
Key Coverage Criteria
- Drug testing services are covered when they meet the medical necessity and coverage indications specified in LCD L36029.
- Medicare Part B will pay for drug screening services when furnished in allowed places of service: office (11), urgent care (20), independent clinic (49), FQHC freestanding (50), RHC freestanding (72), and independent laboratory (81).
- Psychiatric/psychological services are covered when there is a reasonable expectation that withdrawing treatment would cause the patient's condition to deteriorate, relapse, or require hospitalization.
- CORF social and psychological services are covered when indicated and may be provided by qualified social workers (minimum BS) or psychologists (minimum Master’s level).
- Psychiatric diagnostic procedures may be billed once per day and are covered at the outset of an illness or suspected illness, or again for a new episode after a hiatus or on (re)admission for complications of the underlying condition.
- Psychotherapy codes that include an E/M component are payable when performed by physicians, physician assistants (PA), nurse practitioners (NP), or clinical nurse specialists (CNS) and the E/M component is documented in the record.
16 Active Policies
A56937 — Billing and Coding: Psychiatry and Psychology Services
J06
L33632 — Psychiatry and Psychology Services
J06
L34520 — Psychological and Neuropsychological Tests
J09
L33252 — Psychiatric Diagnostic Evaluation and Psychotherapy Services
J09
A57780
Related Codes
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