Autism Spectrum Disorders/Pervasive Developmental Disorders: Assessment and Treatment - (0447)

Medically necessary ASD assessments (behavioral/psychiatric evaluations, autism‑specific screening/testing, EEG when seizures are suspected, speech/OT/PT evaluations, lead screening, select labs and neuroimaging when indicated) and behavioral treatments (behavior modification, psychotherapy, targeted pharmacotherapy) are covered, while numerous interventions are excluded as not medically necessary—examples include MEG, chelation, hyperbaric oxygen, IVIG, transcranial stimulation, many CAM/educational therapies, consumer electronic devices, and proprietary metabolomic panels. Coverage requires meeting DSM‑5 ASD criteria for treatment, services be appropriate in type/frequency/duration and delivered by qualified providers with documentation of medical necessity, measurable expected improvement, and correct CPT/diagnosis coding.

"Behavioral health evaluation including psychiatric examination for suspected or known ASD"