Z86.51 — Personal history of combat and operational stress reaction
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Documentation of prior treatments and rationale for EMDR (e.g., prior unsuccessful or inadequate trials of guideline-recommended therapies when applicable)
- Evidence of therapist training / qualification in EMDR (background states training is considered mandatory for appropriate use) and competence to deliver EMDR protocol
- For special-population uses (e.g., comorbid SUD, psychosis), documentation that inclusion/exclusion criteria and safety monitoring were considered (e.g., exclusion of acute suicidality, psychosis in some trials)
- When EMDR is used as adjunctive therapy, documentation of concurrent 'treatment as usual' modalities and how EMDR integrates with ongoing care
Key Coverage Criteria
- Rheumatoid arthritis pain (studied comparison vs guided imagery)
- Primary dysmenorrhea (protocols exist to study EMDR effects)
- Anxiety disorders (including general anxiety, specific phobia, panic)
- Obsessive-compulsive disorder (EMDR vs CBT compared in RCTs)
- Bipolar disorder — affective relapse prevention (trauma-focused EMDR study protocol)
- Borderline personality disorder (case report of phase-oriented EMDR)
1 Active Policy
AETNA-CPB-0583 — Eye Movement Desensitization and Reprocessing (EMDR) Therapy
Related Codes
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