CG-BEH-15 Activity Therapy for Autism Spectrum Disorders and Rett Syndrome

This policy addresses activity therapy (therapeutic use of music, dance, art, play, theater) for Autism Spectrum Disorders (ASD) and Rett syndrome. It is considered not medically necessary for treating ASD or Rett syndrome and therefore not covered. This applies to all activity therapy modalities; there are no covered indications under this policy, and related claims (e.g., HCPCS/CPT G0176 with ASD/Rett ICD-10 codes such as F84.0, F84.2, F84.3, F84.5, F84.8, F84.9) are noncovered.

"Activity therapy, including but not limited to music, dance, art or play therapies, is considerednot medically necessaryfor the treatment of Autism Spectrum Disorders and Rett syndrome."

Sign up to see full coverage criteria, indications, and limitations.