R62.59 — Other lack of expected normal physiological development in childhood
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- The plan of care should be ongoing (i.e., updated as the patient's condition changes), and treatment should demonstrate reasonable expectation of improvement.
- "A reasonable estimate of when the goals will be reached;"
- "Long-term and short-term goals that are specific, quantitative and objective;"
- "Cognitive therapy evaluation;"
Key Coverage Criteria
- ICD-10 G92.00 - G92.9 Toxic encephalopathy (covered if selection criteria are met).
- Rehabilitation for visuo-spatial deficits (generally entails 20 1-hour sessions delivered over the course of 4 weeks).
- Rehabilitation for language and communication deficits (persons usually receive 8 hours of weekly therapy, beginning at 4 weeks post-onset and continuing up to 48 weeks post-onset).
- Cognitive rehabilitation is considered medically necessary for encephalopathy due to HIV when medical necessity criteria in section I above are met.
- ICD-10 F07.81 Postconcussion syndrome (covered if selection criteria are met).
- Cognitive rehabilitation as adjunctive treatment of cognitive deficits (e.g., attention, language, memory, reasoning, executive functions, problem solving, and visual processing) when performed by a licensed health care professional acting within their scope of practice and all of the following are met: Neuropsychological testing has been performed and neuropsychological results will be used in treatment-planning and directing rehabilitation strategies; and The cognitive deficits have been acqui [...]
10 Active Policies
AMBETTER-CG-Epilepsy-Neurodegen-Neuromusc-DO-2025.1 — Concert Genetic Testing: Epilepsy, Neurodegenerative, and Neuromuscular Conditions
AMBETTER-CG-Multi-Inher-DO.-Intel-Dis.-DD-2025.1 — Concert Genetic Testing: Multisystem Inherited Disorders, Intellectual Disability, and Developmental Delay
AETNA-CPB-0214 — Cognitive Rehabilitation
AETNA-CPB-0220 — Distraction Osteosynthesis
Related Codes
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