Z73.819 — Behavioral insomnia of childhood, unspecified type
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Quantitative EEG must be performed only as an adjunct to a traditional EEG (policy phrase: "medically necessary only as an adjunct to traditional EEG")
- Use must match one of the medically necessary purposes listed (ambulatory recording to facilitate subsequent expert visual EEG interpretation; continuous EEG monitoring by frequency-trending in OR/ICU; evaluation when neuroimaging and routine EEG are inconclusive for cerebrovascular disease; evaluation of dementia/encephalopathy when diagnosis unresolved after initial clinical evaluation; screening for possible epileptic seizures in high-risk ICU members; screening for spikes/seizures during long-term EEG monitoring; topographic voltage and dipole analysis in pre-surgical evaluations for intractable epilepsy)
- Claims for CPT codes 95961 and +95962 and HCPCS S8040 require that the applicable selection criteria be met (policy repeatedly notes "covered if selection criteria are met")
Key Coverage Criteria
- ICD-10 codes covered if selection criteria are met (not all-inclusive): F02.80: Dementia in other diseases classified elsewhere, without behavioral disturbance
- ICD-10 codes covered if selection criteria are met (not all-inclusive): F02.A0, F02.B0, F02.C0, F02.C4: Dementia in other diseases classified elsewhere, with behavioral disturbance
- ICD-10 codes covered if selection criteria are met (not all-inclusive): F03.90 - F03.C4: Unspecified dementia
- ICD-10 codes covered if selection criteria are met (not all-inclusive): F06.1, F06.8: Psychotic disorders with hallucinations and other specified mental disorders due to known physiological conditions
- ICD-10 codes covered if selection criteria are met (not all-inclusive): G40.00 - G40.919: Epilepsy and recurrent seizures
- ICD-10 codes covered if selection criteria are met (not all-inclusive): G92.00 - G92.9: Toxic encephalopathy
1 Active Policy
AETNA-CPB-0221 — Quantitative EEG (Brain Mapping)
Related Codes
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