G11.6 — Leukodystrophy with vanishing white matter disease
ICD-10-CM
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Documentation Required
- Billing, coding, and documentation must comply with the Local Coverage Determination L37638 referenced by this policy.
- Medical record must document the need for psychological evaluation or intervention to manage the physical illness and ADLs.
- Medical record must document that the assessment is not duplicative of other provider assessments.
- Medical record must document the underlying physical illness or injury.
Key Coverage Criteria
- Health and behavior assessment and intervention services are covered when they meet the coverage criteria and documentation requirements specified in Local Coverage Determination L37638.
- Patient has an underlying physical illness or injury.
- There is documented evidence 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 the 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 (ADLs).
- The assessment is not duplicative of other provider assessments.
2 Active Policies
A56562 — Billing and Coding: Health and Behavior Assessment/Intervention
L37638 — Health and Behavior Assessment/Intervention
Related Codes
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