Attention Deficit Hyperactivity Disorder Assessment and Treatment

This policy covers clinical assessment and treatment of Attention Deficit Hyperactivity Disorder (ADHD), including DSM‑5‑based diagnostic interviews, collateral rating scales, psychiatric/psychological evaluations, required laboratory testing prior to stimulant initiation, cardiac/ECG, thyroid or toxicology testing when clinically indicated, pharmacotherapy, behavioral interventions, and ongoing assessment with standardized rating scales. It applies to children, adolescents and adults (with noncomplex pediatric cases manageable in primary care) but excludes or considers not medically necessary many specified diagnostic tests and approaches—such as neuroimaging, pharmacogenetic testing, computerized EEG/attention tests, actigraphy, and numerous other listed laboratory and specialized assessments—due to insufficient evidence or policy limitations.

"Clinical assessment to establish diagnosis of ADHD in children and adults based on defined clinical parameters."