F51.13 — Hypersomnia due to other mental disorder
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.
- Claims must document medical necessity and meet the reasonable and necessary requirements specified in Novitas LCD L35050.
- WatchPAT studies must be billed using CPT 95800 or 95801; actigraphy/CPAP documentation should be billed with CPT 95803 when used for NCD CPAP documentation or when accepted by the DME contractor.
- Providers must check NCCI edits and follow NCCI correct coding guidelines before billing; this policy does not override NCCI.
Key Coverage Criteria
- Outpatient sleep studies that meet the reasonable and necessary clinical criteria in Novitas LCD L35050 are covered.
- Home sleep testing performed with a WatchPAT device should be billed with CPT code 95800 or 95801.
- Actigraphy may be reported with CPT code 95803 to document CPAP coverage under the applicable NCD or as follow-up CPAP administration when accepted by the DME contractor.
- 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.
18 Active Policies
A56937 — Billing and Coding: Psychiatry and Psychology Services
J06
L33632 — Psychiatry and Psychology Services
J06
L33252 — Psychiatric Diagnostic Evaluation and Psychotherapy Services
J09
L34520 — Psychological and Neuropsychological Tests
J09
A57520
Related Codes
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