Medical PolicyMedical Policy
Policy Num: 10.002.002
Policy Name: Clinical Psychology Services
Last Review: July 03, 2025
Next Review: Policy Retired
A Clinical Psychologist refers to a person or health professional who holds a master's or doctoral degree in psychology from an accredited university, college, or center. Practice of psychology includes diagnosis, the application of principles, methods, and procedures to analyze and change human behavior.
These principles include those related to thinking, emotions, perceptions, interpersonal relationships, and learning.
The method may include interviews, consultations, and the performance and interpretation of psychological tests (tests of mental abilities, motivation, aptitudes, and characteristics of the individual's psychological profile).
The Clinical Psychologist must consult with the referring psychiatrist or primary care physician, except when the patient requests that the consultation with the primary care psychiatrist or physician not be carried out. This consultation will not be billed but is required.
To participate in the plan, the following requirements must be met:
• A doctoral degree in clinical psychology from an entity approved by the Council on Postsecondary Accreditation. You may not bill for psychotherapy treatments described in the following codes: 90832, 90834, 90837, 90839, 90840, 90846, 90847, 90849, or 90853.
• A State Board license to practice clinical psychology.
• Two years of experience, one of which must be postdoctoral work.
Triple-S considers for payment outpatient and inpatient diagnostic and therapeutic services that clinical psychologists are permitted to provide under state law.
Triple-S considers for payment outpatient and inpatient diagnostic and therapeutic services that clinical psychologists are permitted to provide under state law.
Payment Policy:
• Interviews and therapies are based on a fee schedule established by Triple-S.
• Therapeutic services include the evaluation, diagnosis, and treatment of emotional and mental disorders, behavior modification, marital, educational, and vocational counseling, and conflict resolution.
• Diagnostic testing is considered for payment according to the fees established by Triple-S.
• These services must be properly documented for subsequent audit purposes.
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BlueCard/National Account Issues
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Triple-S considers for payment outpatient and inpatient diagnostic and therapeutic services that clinical psychologists are permitted to provide under state law.
Payment Policy:
• Interviews and therapies are based on a fee schedule established by Triple-S.
• Therapeutic services include the evaluation, diagnosis, and treatment of emotional and mental disorders, behavior modification, marital, educational, and vocational counseling, and conflict resolution.
• Diagnostic testing is considered for payment according to the fees established by Triple-S.
• These services must be properly documented for subsequent audit purposes.
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1. Hopps, June, and Pauline Collins. "Social Work Profession Overview." In Encyclopedia of Social Work. 19th ed. Edited by Richard Edwards and June Hopps. Washington, D.C.: NASW Press, 1995.
2. The effectiveness of psychotherapy: The Consumer Reports study. Seligman, Martin E. P. American Psychologist. Vol 50(12), Dec 1995, 965-974.
3. Current Procedural terminlogy (CPT-2016) American Medical Association
| CPT | Description |
| 90832 | Psychotherapy, 30 minutes with patient and/or family member |
| 90834 | Psychotherapy, 45 minutes with patient and/or family member |
| 90837 | Psychotherapy, 60 minutes with patient and/or family member |
| 90839 | Multiple-family group psychotherapy |
| 90840 | Add-on for each additional 30 minutes of psychotherapy for crisis, used in conjunction with code 90839 |
| 90846 | Family Psychotherapy (without the patient present) |
| 90847 | Family Psychotherapy (conjoint psychotherapy)(with the patient present) |
| 90849 | Multiple-family group psychotherapy |
| 90853 | Group psychotherapy (other than of a multiple-family group) |
| ICD-10 CM | Description |
| F01.50 | dementia without behavioral disturbance Vascular dementia without behavioral disturbance |
| F01.51 | dementia with behavioral disturbance Vascular dementia with behavioral |
| F02.80 | in oth diseases classd elswhr w/o behavrl disturb Dementia in other diseases classified elsewhere without behavioral disturbance |
| F02.81 | in oth diseases classd elswhr w behavioral disturb Dementia in other diseases classified elsewhere with behavioral disturbance |
| | dementia without behavioral disturbance Unspecified dementia without behavioral disturbance |
| F03.91 | dementia with behavioral disturbance Unspecified dementia with behavioral disturbance |
| | disorder due to known physiological condition Amnestic disorder due to known physiological condition |
| F05 | due to known physiological condition Delirium due to known physiological condition |
| | disorder w hallucin due to known physiol condition Psychotic disorder with hallucinations due to known physiological condition |
| | disorder due to known physiological condition Catatonic disorder due to known physiological condition |
| | disorder w delusions due to known physiol cond Psychotic disorder with delusions due to known physiological condition |
| | disorder due to known physiological condition, unsp Mood disorder due to known physiological condition, unspecified |
| | disorder due to known physiological condition Anxiety disorder due to known physiological condition |
| F06.8 | mental disorders due to known physiological condition Other specified mental disorders due to known physiological condition |
| F07.0 | change due to known physiological condition Personality change due to known physiological condition |
| F07.81 | syndrome Postconcussional syndrome |
| F07.89 | personality & behavrl disord due to known physiol cond Other personality and behavioral disorders due to known physiological condition |
| F09 | mental disorder due to known physiological condition Unspecified mental disorder due to known physiological condition |
| F10.10 | abuse, uncomplicated Alcohol abuse, uncomplicated |
| F10.159 | abuse with alcohol-induced psychotic disorder, unsp Alcohol abuse with alcohol-induced psychotic disorder, unspecified |
| F10.180 | abuse with alcohol-induced anxiety disorder Alcohol abuse with alcohol-Induced anxiety disorder |
| F10.181 | abuse with alcohol-induced sexual dysfunction Alcohol abuse with alcohol- induced sexual dysfunction |
| F10.182 | abuse with alcohol-induced sleep disorder Alcohol abuse with alcohol- induced sleep disorder |
| F10.188 | abuse with other alcohol-induced disorder Alcohol abuse with other alcohol- induced disorder |
| F10.20 | dependence, uncomplicated Alcohol dependence, uncomplicated |
| F10.229 | dependence with intoxication, unspecified Alcohol dependence with intoxication, unspecified |
| | dependence with withdrawal delirium Alcohol dependence with withdrawal delirium |
| F10.239 | dependence with withdrawal, unspecified Alcohol dependence with withdrawal, unspecified |
| | dependence w alcoh-induce psychotic disorder, unsp Alcohol dependence with alcohol-induced psychotic disorder, unspecified |
| F10.27 | dependence with alcohol-induced persisting dementia Alcohol dependence with alcohol-induced persisting dementia |
| | dependence with alcohol-induced anxiety disorder Alcohol dependence with alcohol-induced anxiety disorder |
| | dependence with alcohol-induced sexual dysfunction Alcohol dependence with alcohol-induced sexual dysfunction |
| | dependence with alcohol-induced sleep disorder Alcohol dependence with alcohol-induced sleep disorder |
| | dependence with other alcohol-induced disorder Alcohol dependence with other alcohol-induced disorder |
| | use, unspecified with intoxication, unspecified Alcohol use, unspecified with intoxication, unspecified |
| | use, unsp w alcoh-induce psych disorder w delusions Alcohol use, unspecified with alcohol-induced psychotic disorder with delusions |
| | use, unsp w alcoh-induce psych disorder w hallucin Alcohol use, unspecified with alcohol-induced psychotic disorder with hallucinations |
| | use, unsp w alcohol-induced psychotic disorder, unsp Alcohol use, unspecified with alcohol-induced psychotic disorder, unspecified |
| | use, unsp w alcoh-induce persist amnestic disorder Alcohol use, unspecified with alcohol-induced persisting amnestic disorder |
| | use, unsp with alcohol-induced anxiety disorder Alcohol use, unspecified |
| F10.982 | use, unspecified with alcohol-induced sleep disorder Alcohol use, unspecified with alcohol-induced sleep disorder |
| | use, unsp with unspecified alcohol-induced disorder Alcohol use, unspecified with unspecified alcohol-induced disorder |
| F11.10 | abuse, uncomplicated Opioid abuse, uncomplicated |
| F11.159 | abuse with opioid-induced psychotic disorder, unsp Opioid abuse with opioid-induced psychotic disorder, unspecified |
| | abuse with opioid-induced sexual dysfunction Opioid abuse with opioid- induced sexual dysfunction |
| | abuse with opioid-induced sleep disorder Opioid abuse with opioid-induced sleep disorder |
| F11.188 | abuse with other opioid-induced disorder Opioid abuse with other opioid- induced disorder |
| F11.21 | dependence, in remission Opioid dependence, in remission |
| F11.222 | dependence w intoxication with perceptual disturbance Opioid dependence with intoxication with perceptual disturbance |
| | dependence w opioid-induced psychotic disorder, unsp Opioid dependence with opioid-induced psychotic disorder, unspecified |
| | dependence with opioid-induced sexual dysfunction Opioid dependence with opioid-induced sexual dysfunction |
| | dependence with opioid-induced sleep disorder Opioid dependence with opioid-induced sleep disorder |
| | dependence with other opioid-induced disorder Opioid dependence with other opioid-induced disorder |
| | use, unsp w intoxication with perceptual disturbance Opioid use, unspecified with intoxication with perceptual disturbance |
| F11.959 | use, unsp w opioid-induced psychotic disorder, unsp Opioid use, unspecified |
| F11.981 | use, unsp with opioid-induced sexual dysfunction Opioid use, unspecified with opioid-induced sexual dysfunction |
| | use, unspecified with opioid-induced sleep disorder Opioid use, unspecified with opioid-induced sleep disorder |
| | use, unspecified with other opioid-induced disorder Opioid use, unspecified with other opioid-induced disorder |
| F12.10 | abuse, uncomplicated Cannabis abuse, uncomplicated |
| F12.122 | abuse with intoxication with perceptual disturbance Cannabis abuse with intoxication with perceptual disturbance |
| | abuse with psychotic disorder, unspecified Cannabis abuse with psychotic |
| F12.180 | abuse with cannabis-induced anxiety disorder Cannabis abuse with cannabis-induced anxiety disorder |
| | abuse with other cannabis-induced disorder Cannabis abuse with other cannabis-induced disorder |
| F12.20 | dependence, uncomplicated Cannabis dependence, uncomplicated |
| F12.21 | dependence, in remission Cannabis dependence, in remission |
| F12.222 | dependence w intoxication w perceptual disturbance Cannabis dependence with intoxication with perceptual disturbance |
| | dependence with psychotic disorder, unspecified Cannabis dependence with psychotic disorder, unspecified |
| F12.280 | dependence with cannabis-induced anxiety disorder Cannabis dependence with cannabis-induced anxiety disorder |
| | dependence with other cannabis-induced disorder Cannabis dependence |
| F12.90 | use, unspecified, uncomplicated Cannabis use, unspecified, uncomplicated |
| F12.922 | use, unsp w intoxication w perceptual disturbance Cannabis use, unspecified with intoxication with perceptual disturbance |
| | use, unsp with psychotic disorder, unspecified Cannabis use, unspecified with psychotic disorder, unspecified |
| | use, unspecified with anxiety disorder Cannabis use, unspecified with anxiety disorder |
| F12.988 | use, unsp with other cannabis-induced disorder Cannabis use, unspecified with other cannabis-induced disorder |
| F13.10 | hypnotic or anxiolytic abuse, uncomplicated Sedative, hypnotic or anxiolytic abuse, uncomplicated |
| F13.159 | abuse w psychotic disorder, unsp Sedative, hypnotic or anxiolytic abuse with sedative, hypnotic or anxiolytic-induced psychotic disorder, unspecified |
| F13.180 | hypnotic or anxiolytic abuse w anxiety disorder Sedative, hypnotic or anxiolytic abuse with sedative, hypnotic or anxiolytic-induced anxiety disorder |
| F13.181 | hypnotic or anxiolytic abuse w sexual dysfunction Sedative, hypnotic or anxiolytic abuse with sedative, hypnotic or anxiolytic-induced sexual dysfunction |
| F13.182 | hypnotic or anxiolytic abuse w sleep disorder Sedative, hypnotic or anxiolytic abuse with sedative, hypnotic or anxiolytic-induced sleep disorder |
| | hypnotic or anxiolytic abuse w oth disorder Sedative, hypnotic or anxiolytic abuse with other sedative, hypnotic or anxiolytic-induced disorder |
| | hypnotic or anxiolytic dependence, uncomplicated Sedative, hypnotic or |
| F13.21 | hypnotic or anxiolytic dependence, in remission Sedative, hypnotic or anxiolytic dependence, in remission |
| F13.259 | dependence w psychotic disorder, unsp Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced psychotic disorder, unspecified |
| F13.280 | dependence w anxiety disorder Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced anxiety disorder |
| F13.281 | dependence w sexual dysfunction Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced sexual dysfunction |
| | hypnotic or anxiolytic dependence w sleep disorder Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced sleep disorder |
| | hypnotic or anxiolytic dependence w oth disorder Sedative, hypnotic or anxiolytic dependence with other sedative, hypnotic or anxiolytic-induced disorder |
| | use, unsp w psychotic disorder, unsp Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced psychotic disorder, unspecified |
| | use, unsp w anxiety disorder Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced anxiety disorder |
| F13.981 | use, unsp w sexual dysfunction Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced sexual dysfunction |
| | hypnotic or anxiolytic use, unsp w sleep disorder Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced sleep disorder |
| | hypnotic or anxiolytic use, unsp w oth disorder Sedative, hypnotic or anxiolytic use, unspecified with other sedative, hypnotic or anxiolytic-induced disorder |
| F14.10 | abuse, uncomplicated Cocaine abuse, uncomplicated |
| F14.122 | abuse with intoxication with perceptual disturbance Cocaine abuse with intoxication with perceptual disturbance |
| F14.159 | abuse with cocaine-induced psychotic disorder, unsp Cocaine abuse with cocaine-induced psychotic disorder, unspecified |
| F14.180 | abuse with cocaine-induced anxiety disorder Cocaine abuse with cocaine- induced anxiety disorder |
| F14.181 | abuse with cocaine-induced sexual dysfunction Cocaine abuse with cocaine-induced sexual dysfunction |
| | abuse with cocaine-induced sleep disorder Cocaine abuse with cocaine-induced sleep disorder |
| F14.188 | abuse with other cocaine-induced disorder Cocaine abuse with other cocaine-induced disorder |
| F14.20 | dependence, uncomplicated Cocaine dependence, uncomplicated |
| F14.21 | dependence, in remission Cocaine dependence, in remission |
| F14.222 | dependence w intoxication w perceptual disturbance Cocaine dependence with intoxication with perceptual disturbance |
| | dependence w cocaine-induc psychotic disorder, unsp Cocaine dependence with cocaine-induced psychotic disorder, unspecified |
| | dependence with cocaine-induced anxiety disorder Cocaine dependence with cocaine-induced anxiety disorder |
| | dependence with cocaine-induced sexual dysfunction Cocaine dependence with cocaine-induced sexual dysfunction |
| | dependence with cocaine-induced sleep disorder Cocaine dependence with cocaine-induced sleep disorder |
| | dependence with other cocaine-induced disorder Cocaine dependence with other cocaine-induced disorder |
| | use, unsp w intoxication with perceptual disturbance Cocaine use, unspecified with intoxication with perceptual disturbance |
| | use, unsp w cocaine-induced psychotic disorder, unsp Cocaine use, unspecified with cocaine-induced psychotic disorder, unspecified |
| | use, unsp with cocaine-induced anxiety disorder Cocaine use, unspecified with cocaine-induced anxiety disorder |
| | use, unsp with cocaine-induced sexual dysfunction Cocaine use, unspecified with cocaine-induced sexual dysfunction |
| F14.982 | use, unspecified with cocaine-induced sleep disorder Cocaine use, unspecified with cocaine-induced sleep disorder |
| F14.988 | use, unspecified with other cocaine-induced disorder Cocaine use, unspecified with other cocaine-induced disorder |
| F15.10 | stimulant abuse, uncomplicated Other stimulant abuse, uncomplicated |
| F15.122 | stimulant abuse w intoxication w perceptual disturbance Other stimulant abuse with intoxication with perceptual disturbance |
| | stimulant abuse w stim-induce psychotic disorder, unsp Other stimulant abuse with stimulant-induced psychotic disorder, unspecified |
| | stimulant abuse with stimulant-induced anxiety disorder Other stimulant abuse with stimulant-induced anxiety disorder |
| | stimulant abuse w stimulant-induced sexual dysfunction Other stimulant abuse with stimulant-induced sexual dysfunction |
| | stimulant abuse with stimulant-induced sleep disorder Other stimulant abuse with stimulant-induced sleep disorder |
| F15.188 | stimulant abuse with other stimulant-induced disorder Other stimulant abuse with other stimulant-induced disorder |
| F15.20 | stimulant dependence, uncomplicated Other stimulant dependence, uncomplicated |
| F15.21 | stimulant dependence, in remission Other stimulant dependence, in remission |
| F15.222 | stimulant dependence w intox w perceptual disturbance Other stimulant dependence with intoxication with perceptual disturbance |
| | stimulant depend w stim-induce psychotic disorder, unsp Other stimulant dependence with stimulant-induced psychotic disorder, unspecified |
| | stimulant dependence w stim-induce anxiety disorder Other stimulant dependence with stimulant-induced anxiety disorder |
| | stimulant dependence w stim-induce sexual dysfunction Other stimulant dependence with stimulant-induced sexual dysfunction |
| | stimulant dependence w stimulant-induced sleep disorder Other stimulant dependence with stimulant-induced sleep disorder |
| | stimulant dependence with oth stimulant-induced disorder Other stimulant dependence with other stimulant-induced disorder |
| | stimulant use, unsp with intoxication, uncomplicated Other stimulant use, unspecified with intoxication, uncomplicated |
| | stimulant use, unsp w intox w perceptual disturbance Other stimulant use, unspecified with intoxication with perceptual disturbance |
| | stimulant use, unsp w stim-induce psych disorder, unsp Other stimulant use, unspecified with stimulant-induced psychotic disorder, unspecified |
| | stimulant use, unsp w stimulant-induced anxiety disorder Other stimulant use, unspecified with stimulant-induced anxiety disorder |
| F15.981 | stimulant use, unsp w stim-induce sexual dysfunction Other stimulant use, unspecified with stimulant-induced sexual dysfunction |
| | stimulant use, unsp w stimulant-induced sleep disorder Other stimulant use, unspecified with stimulant-induced sleep disorder |
| | stimulant use, unsp with oth stimulant-induced disorder Other stimulant use, unspecified with other stimulant-induced disorder |
| F16.10 | abuse, uncomplicated Hallucinogen abuse, uncomplicated |
| F16.122 | abuse w intoxication w perceptual disturbance Hallucinogen abuse with intoxication with perceptual disturbance |
| | abuse w psychotic disorder, unsp Hallucinogen abuse with hallucinogen- induced psychotic disorder, unspecified |
| F16.180 | abuse w hallucinogen-induced anxiety disorder Hallucinogen abuse with hallucinogen-induced anxiety disorder |
| F16.183 | abuse w hallucign persisting perception disorder Hallucinogen abuse with hallucinogen persisting perception disorder (flashbacks) |
| F16.188 | abuse with other hallucinogen-induced disorder Hallucinogen abuse with other hallucinogen-induced disorder |
| F16.20 | dependence, uncomplicated Hallucinogen dependence, uncomplicated |
| F16.21 | dependence, in remission Hallucinogen dependence, in remission |
| F16.259 | dependence w psychotic disorder, unsp Hallucinogen dependence with hallucinogen-induced psychotic disorder, unspecified |
| | dependence w anxiety disorder Hallucinogen dependence with hallucinogen-induced anxiety disorder |
| | depend w hallucign persisting perception disorder Hallucinogen dependence with hallucinogen persisting perception disorder (flashbacks) |
| | dependence w oth hallucinogen-induced disorder Hallucinogen dependence |
| F16.959 | use, unsp w psychotic disorder, unsp Hallucinogen use, unspecified with hallucinogen-induced psychotic disorder, unspecified |
| | use, unsp w anxiety disorder Hallucinogen use, unspecified with hallucinogen-induced anxiety disorder |
| | use, unsp w hallucign persist perception disorder Hallucinogen use, unspecified with hallucinogen persisting perception disorder (flashbacks) |
| | use, unsp w oth hallucinogen-induced disorder Hallucinogen use, unspecified with other hallucinogen-induced disorder |
| | dependence, unspecified, uncomplicated Nicotine dependence, unspecified, uncomplicated |
| | dependence, unsp, w oth nicotine-induced disorders Nicotine dependence, unspecified, with other nicotine-induced disorders |
| F17.21 | dependence, cigarettes, w oth disorders Nicotine dependence, cigarettes, |
| F17.228 | dependence, chewing tobacco, w oth disorders Nicotine dependence, chewing tobacco, with other nicotine-induced disorders |
| | dependence, oth tobacco product, w oth disorders Nicotine dependence, other tobacco product, with other nicotine-induced disorders |
| F18.10 | abuse, uncomplicated Inhalant abuse, uncomplicated |
| F18.159 | abuse w inhalant-induced psychotic disorder, unsp Inhalant abuse with inhalant-induced psychotic disorder, unspecified |
| | abuse with inhalant-induced anxiety disorder Inhalant abuse with inhalant- induced anxiety disorder |
| F18.188 | abuse with other inhalant-induced disorder Inhalant abuse with other inhalant-induced disorder |
| F18.259 | depend w inhalnt-induce psychotic disorder, unsp Inhalant dependence with |
| F18.280 | dependence with inhalant-induced anxiety disorder Inhalant dependence with inhalant-induced anxiety disorder |
| F18.288 | dependence with other inhalant-induced disorder Inhalant dependence with other inhalant-induced disorder |
| | use, unsp w inhalnt-induce psychotic disorder, unsp Inhalant use, unspecified with inhalant-induced psychotic disorder, unspecified |
| | use, unsp with inhalant-induced anxiety disorder Inhalant use, unspecified with inhalant-induced anxiety disorder |
| | use, unsp with other inhalant-induced disorder Inhalant use, unspecified with other inhalant-induced disorder |
| | psychoactive substance abuse, uncomplicated Other psychoactive substance abuse, uncomplicated |
| | psychoactv substance abuse w intox w perceptual disturb Other psychoactive substance abuse with intoxication with perceptual disturbances |
| | psychoactive substance abuse w psychotic disorder, unsp Other psychoactive substance abuse with psychoactive substance-induced psychotic disorder, unspecified |
| F19.180 | psychoactive substance abuse w anxiety disorder Other psychoactive substance abuse with psychoactive substance-induced anxiety disorder |
| | psychoactive substance abuse w sexual dysfunction Other psychoactive substance abuse with psychoactive substance-induced sexual dysfunction |
| F19.182 | psychoactive substance abuse w sleep disorder Other psychoactive substance abuse with psychoactive substance-induced sleep disorder |
| | psychoactive substance abuse w oth disorder Other psychoactive substance abuse with other psychoactive substance-induced disorder |
| | psychoactive substance dependence, uncomplicated Other psychoactive substance dependence, uncomplicated |
| | psychoactive substance dependence, in remission Other psychoactive substance dependence, in remission |
| | psychoactv substance depend w intox w perceptual disturb Other psychoactive substance dependence with intoxication with perceptual disturbance |
| | psychoactv substance depend w psychotic disorder, unsp Other psychoactive substance dependence with psychoactive substance-induced psychotic disorder, unspecified |
| | psychoactive substance dependence w anxiety disorder Other psychoactive substance dependence with psychoactive substance-induced anxiety disorder |
| | psychoactive substance dependence w sexual dysfunction Other psychoactive substance dependence with psychoactive substance-induced sexual dysfunction |
| F19.282 | psychoactive substance dependence w sleep disorder Other psychoactive substance dependence with psychoactive substance-induced sleep disorder |
| | psychoactive substance dependence w oth disorder Other psychoactive substance dependence with other psychoactive substance-induced disorder |
| | psychoactive substance use, unsp w intox w delirium Other psychoactive substance use, unspecified with intoxication with delirium |
| F19.922 | psychoactv sub use, unsp w intox w perceptl disturb Other psychoactive substance use, unspecified with intoxication with perceptual disturbance |
| | psychoactive substance use, unsp with withdrawal, unsp Other psychoactive substance use, unspecified with withdrawal, unspecified |
| | psychoactive substance use, unsp w mood disorder Other psychoactive substance use, unspecified with psychoactive substance-induced mood disorder |
| | psychoactv sub use, unsp w psych disorder w delusions Other psychoactive substance use, unspecified with psychoactive substance-induced psychotic disorder with delusions |
| | psychoactv sub use, unsp w psych disorder w hallucin Other psychoactive substance use, unspecified with psychoactive substance-induced psychotic disorder with hallucinations |
| | psychoactv substance use, unsp w psych disorder, unsp Other psychoactive substance use, unspecified with psychoactive substance-induced psychotic disorder, unspecified |
| | psychoactv sub use, unsp w persist amnestic disorder Other psychoactive substance use, unspecified with psychoactive substance-induced persisting amnestic disorder |
| | psychoactive substance use, unsp w persisting dementia Other psychoactive substance use, unspecified with psychoactive substance- induced persisting dementia |
| | psychoactive substance use, unsp w anxiety disorder Other psychoactive substance use, unspecified with psychoactive substance-induced anxiety disorder |
| | psychoactive substance use, unsp w sexual dysfunction Other psychoactive substance use, unspecified with psychoactive substance-induced sexual |
| | psychoactive substance use, unsp w sleep disorder Other psychoactive substance use, unspecified with psychoactive substance-induced sleep disorder |
| F19.988 | psychoactive substance use, unsp w oth disorder Other psychoactive substance use, unspecified with other psychoactive substance-induced disorder |
| | psychoactive substance use, unsp w unsp disorder Other psychoactive substance use, unspecified with unspecified psychoactive substance- induced disorder |
| F20.0 | schizophrenia Paranoid schizophrenia |
| F20.1 | schizophrenia Disorganized schizophrenia |
| F20.2 | schizophrenia Catatonic schizophrenia |
| F20.5 | schizophrenia Residual schizophrenia |
| F20.81 | disorder Schizophreniform disorder |
| F20.89 | schizophrenia Other schizophrenia |
| F20.9 | unspecified Schizophrenia, unspecified |
| F21 | disorder Schizotypal disorder |
| F22 | disorders Delusional disorders |
| F23 | psychotic disorder Brief psychotic disorder |
| F24 | psychotic disorder Shared psychotic disorder |
| F25.9 | disorder, unspecified Schizoaffective disorder, unspecified |
| F28 | psych disorder not due to a sub or known physiol cond Other psychotic disorder not due to a substance or known physiological condition |
| | psychosis not due to a substance or known physiol cond Unspecified |
| | episode without psychotic symptoms, unspecified Manic episode without psychotic symptoms, unspecified |
| | episode without psychotic symptoms, mild Manic episode without psychotic symptoms, mild |
| | episode without psychotic symptoms, moderate Manic episode without psychotic symptoms, moderate |
| | episode, severe, without psychotic symptoms Manic episode, severe, without psychotic symptoms |
| | episode, severe with psychotic symptoms Manic episode, severe with psychotic symptoms |
| F30.3 | episode in partial remission Manic episode in partial remission |
| F30.4 | episode in full remission Manic episode in full remission |
| F30.8 | manic episodes Other manic episodes |
| | disord, crnt episode manic w/o psych features, unsp Bipolar disorder, current episode manic without psychotic features, unspecified |
| F31.11 | disord, crnt episode manic w/o psych features, mild Bipolar disorder, current episode manic without psychotic features, mild |
| | disord, crnt episode manic w/o psych features, mod Bipolar disorder, current episode manic without psychotic features, moderate |
| | disord, crnt epsd manic w/o psych features, severe Bipolar disorder, current episode manic without psychotic features, severe |
| | disord, crnt episode manic severe w psych features Bipolar disorder, current episode manic severe with psychotic features |
| | disord, crnt epsd depress, mild or mod severt, unsp Bipolar disorder, current episode depressed, mild or moderate severity, unspecified |
| | disorder, current episode depressed, mild Bipolar disorder, current episode depressed, mild |
| | disorder, current episode depressed, moderate Bipolar disorder, current episode depressed, moderate |
| | disord, crnt epsd depress, sev, w/o psych features Bipolar disorder, current episode depressed, severe, without psychotic features |
| | disord, crnt epsd depress, severe, w psych features Bipolar disorder, current episode depressed, severe, with psychotic features |
| | disorder, current episode mixed, unspecified Bipolar disorder, current episode mixed, unspecified |
| | disorder, current episode mixed, mild Bipolar disorder, current episode mixed, mild |
| | disorder, current episode mixed, moderate Bipolar disorder, current episode mixed, moderate |
| | disord, crnt epsd mixed, severe, w/o psych features Bipolar disorder, current episode mixed, severe, without psychotic features |
| | disord, crnt episode mixed, severe, w psych features Bipolar disorder, current episode mixed, severe, with psychotic features |
| | disord, in partial remis, most recent episode manic Bipolar disorder, in partial remission, most recent episode manic |
| | disorder, in full remis, most recent episode manic Bipolar disorder, in full remission, most recent episode manic |
| | disord, in partial remis, most recent epsd depress Bipolar disorder, in partial remission, most recent episode depressed |
| | disorder, in full remis, most recent episode depress Bipolar disorder, in full |
| F31.77 | disord, in partial remis, most recent episode mixed Bipolar disorder, in partial remission, most recent episode mixed |
| | disorder, in full remis, most recent episode mixed Bipolar disorder, in full remission, most recent episode mixed |
| F31.81 | II disorder Bipolar II disorder |
| F31.9 | disorder, unspecified Bipolar disorder, unspecified |
| F32.0 | depressive disorder, single episode, mild Major depressive disorder, single episode, mild |
| | depressive disorder, single episode, moderate Major depressive disorder, single episode, moderate |
| F32.2 | depressv disord, single epsd, sev w/o psych features Major depressive disorder, single episode, severe without psychotic features |
| | depressv disord, single epsd, severe w psych features Major depressive |
| F32.4 | depressv disorder, single episode, in partial remis Major depressive disorder, single episode, in partial remission |
| | depressive disorder, single episode, in full remission Major depressive disorder, single episode, in full remission |
| F32.8 | depressive episodes Other depressive episodes |
| F32.9 | depressive disorder, single episode, unspecified Major depressive disorder, single episode, unspecified |
| | depressive disorder, recurrent, mild Major depressive disorder, recurrent, mild |
| | depressive disorder, recurrent, moderate Major depressive disorder, recurrent, moderate |
| F33.2 | depressv disorder, recurrent severe w/o psych features Major depressive disorder, recurrent severe without psychotic features |
| | depressv disorder, recurrent, severe w psych symptoms Major depressive disorder, recurrent, severe with psychotic symptoms |
| | depressive disorder, recurrent, in partial remission Major depressive disorder, recurrent, in partial remission |
| F33.42 | depressive disorder, recurrent, in full remission Major depressive disorder, recurrent, in full remission |
| | depressive disorder, recurrent, unspecified Major depressive disorder, recurrent, unspecified |
| F34.0 | disorder Cyclothymic disorder |
| F34.1 | disorder Dysthymic disorder |
| F39 | mood [affective] disorder Unspecified mood [affective] disorder |
| F40.01 | with panic disorder Agoraphobia with panic disorder |
| F40.02 | without panic disorder Agoraphobia without panic disorder |
| F40.10 | phobia, unspecified Social phobia, unspecified |
| F40.218 | animal type phobia Other animal type phobia |
| F40.240 | Claustrophobia |
| F40.241 | Acrophobia |
| F40.8 | phobic anxiety disorders Other phobic anxiety disorders |
| F40.9 | anxiety disorder, unspecified Phobic anxiety disorder, unspecified |
| F41.0 | disorder without agoraphobia Panic disorder [episodic paroxysmal anxiety] without agoraphobia |
| F41.1 | anxiety disorder Generalized anxiety disorder |
| F41.8 | specified anxiety disorders Other specified anxiety disorders |
| F41.9 | disorder, unspecified Anxiety disorder, unspecified |
| F42 | disorder Obsessive-compulsive disorder |
| F43.0 | stress reaction Acute stress reaction |
| F43.10 | stress disorder, unspecified Post-traumatic stress disorder, unspecified |
| F43.12 | stress disorder, chronic Post-traumatic stress disorder, chronic |
| F43.20 | disorder, unspecified Adjustment disorder, unspecified |
| F43.21 | disorder with depressed mood Adjustment disorder with depressed mood |
| F43.22 | disorder with anxiety Adjustment disorder with anxiety |
| F43.23 | disorder with mixed anxiety and depressed mood Adjustment disorder with mixed anxiety and depressed mood |
| | disorder with disturbance of conduct Adjustment disorder with disturbance of conduct |
| | disorder w mixed disturb of emotions and conduct Adjustment disorder with mixed disturbance of emotions and conduct |
| F43.29 | disorder with other symptoms Adjustment disorder with other symptoms |
| F43.8 | reactions to severe stress Other reactions to severe stress |
| F44.0 | amnesia Dissociative amnesia |
| F44.1 | fugue Dissociative fugue |
| F44.4 | disorder with motor symptom or deficit Conversion disorder with motor symptom or deficit |
| | disorder with sensory symptom or deficit Conversion disorder with sensory symptom or deficit |
| F44.81 | identity disorder Dissociative identity disorder |
| F44.89 | dissociative and conversion disorders Other dissociative and conversion disorders |
| | and conversion disorder, unspecified Dissociative and conversion disorder, unspecified |
| F45.0 | disorder Somatization disorder |
| F45.1 | somatoform disorder Undifferentiated somatoform disorder |
| F45.21 | Hypochondriasis |
| F45.22 | dysmorphic disorder Body dysmorphic disorder |
| | disorder exclusively related to psychological factors Pain disorder exclusively related to psychological factors |
| | disorder with related psychological factors Pain disorder with related psychological factors |
| F45.8 | somatoform disorders Other somatoform disorders |
| F45.9 | disorder, unspecified Somatoform disorder, unspecified |
| F48.1 | syndrome Depersonalization-derealization syndrome |
| F48.2 | affect Pseudobulbar affect |
| | specified nonpsychotic mental disorders Other specified nonpsychotic mental disorders |
| F48.9 | mental disorder, unspecified Nonpsychotic mental disorder, unspecified |
| F50.00 | nervosa, unspecified Anorexia nervosa, unspecified |
| F50.2 | nervosa Bulimia nervosa |
| F50.9 | disorder, unspecified Eating disorder, unspecified |
| F51.01 | insomnia Primary insomnia |
| F51.02 | insomnia Adjustment insomnia |
| F51.03 | insomnia Paradoxical insomnia |
| | insomnia not due to a substance or known physiol cond Other insomnia not due to a substance or known physiological condition |
| F51.11 | hypersomnia Primary hypersomnia |
| F51.12 | sleep syndrome Insufficient sleep syndrome |
| | hypersomnia not due to a substance or known physiol cond Other hypersomnia not due to a substance or known physiological condition |
| F51.3 | [somnambulism] Sleepwalking [somnambulism] |
| | sleep disord not due to a sub or known physiol cond Other sleep disorders not due to a substance or known physiological condition |
| | disorder not due to a sub or known physiol cond, unsp Sleep disorder not due to a substance or known physiological condition, unspecified |
| F52.0 | sexual desire disorder Hypoactive sexual desire disorder |
| F52.1 | aversion disorder Sexual aversion disorder |
| F52.21 | erectile disorder Male erectile disorder |
| F52.31 | orgasmic disorder Female orgasmic disorder |
| F52.32 | orgasmic disorder Male orgasmic disorder |
| F52.4 | ejaculation Premature ejaculation |
| F52.5 | not due to a substance or known physiol condition Vaginismus not due to a substance or known physiological condition |
| F52.6 | not due to a substance or known physiol cond Dyspareunia not due to a substance or known physiological condition |
| F52.8 | sexual dysfnct not due to a sub or known physiol cond Other sexual dysfunction not due to a substance or known physiological condition |
| F53 | psychosis Puerperal psychosis |
| | & behavrl factors assoc w disord or dis classd elswhr Psychological and |
| | behavrl synd assoc w physiol disturb and physcl factors Unspecified behavioral syndromes associated with physiological disturbances and physical factors |
| F60.0 | personality disorder Paranoid personality disorder |
| F60.1 | personality disorder Schizoid personality disorder |
| F60.2 | personality disorder Antisocial personality disorder |
| F60.3 | personality disorder Borderline personality disorder |
| F60.4 | personality disorder Histrionic personality disorder |
| F60.5 | personality disorder Obsessive-compulsive personality disorder |
| F60.6 | personality disorder Avoidant personality disorder |
| F60.7 | personality disorder Dependent personality disorder |
| F60.81 | personality disorder Narcissistic personality disorder |
| F60.89 | specific personality disorders Other specific personality disorders |
| F60.9 | disorder, unspecified Personality disorder, unspecified |
| F63.0 | gambling Pathological gambling |
| F63.1 | Pyromania |
| F63.2 | Kleptomania |
| F63.3 | Trichotillomania |
| F63.81 | explosive disorder Intermittent explosive disorder |
| F63.89 | impulse disorders Other impulse disorders |
| F63.9 | disorder, unspecified Impulse disorder, unspecified |
| F64.1 | identity disorder in adolescence and adulthood Gender identity disorder in adolescence and adulthood |
| F64.2 | identity disorder of childhood Gender identity disorder of childhood |
| F65.0 | Fetishism |
| F65.2 | Exhibitionism |
| F65.3 | Voyeurism |
| F65.4 | Pedophilia |
| F65.51 | masochism Sexual masochism |
| F65.52 | sadism Sexual sadism |
| F65.81 | Frotteurism |
| F65.89 | paraphilias Other paraphilias |
| F65.9 | unspecified Paraphilia, unspecified |
| F66 | sexual disorders Other sexual disorders |
| F68.11 | disorder w predom psych signs and symptoms Factitious disorder with predominantly psychological signs and symptoms |
| F68.12 | disorder w predom physical signs and symptoms Factitious disorder with predominantly physical signs and symptoms |
| F68.8 | specified disorders of adult personality and behavior Other specified disorders of adult personality and behavior |
| F70 | intellectual disabilities Mild intellectual disabilities |
| F71 | intellectual disabilities Moderate intellectual disabilities |
| F72 | Severe mental retardation |
| F73 | Profound mental retardation |
| F79 | intellectual disabilities Unspecified intellectual disabilities |
| F80.0 | disorder Phonological disorder |
| F80.1 | language disorder Expressive language disorder |
| F80.2 | receptive-expressive language disorder Mixed receptive-expressive language disorder |
| F80.4 | and language development delay due to hearing loss Speech and language development delay due to hearing loss |
| F80.81 | onset fluency disorder Childhood onset fluency disorder |
| F80.89 | developmental disorders of speech and language Other developmental disorders of speech and language |
| F81.0 | reading disorder Specific reading disorder |
| F81.2 | disorder Mathematics disorder |
| F81.81 | of written expression Disorder of written expression |
| F81.89 | developmental disorders of scholastic skills Other developmental disorders of scholastic skills |
| F81.9 | disorder of scholastic skills, unspecified Developmental disorder of scholastic skills, unspecified |
| F82 | developmental disorder of motor function Specific developmental disorder of motor function |
| F84.0 | disorder Autistic disorder |
| F84.3 | childhood disintegrative disorder Other childhood disintegrative disorder |
| F84.5 | syndrome Asperger's syndrome |
| F84.8 | pervasive developmental disorders Other pervasive developmental disorders |
| F84.9 | developmental disorder, unspecified Pervasive developmental disorder, unspecified |
| F88 | disorders of psychological development Other disorders of psychological development |
| F89 | disorder of psychological development Unspecified disorder of psychological development |
| F90.0 | hyperactivity disorder, predom inattentive type Attention-deficit hyperactivity disorder, predominantly inattentive type |
| F90.1 | hyperactivity disorder, predom hyperactive type Attention-deficit hyperactivity disorder, predominantly hyperactive type |
| F90.2 | hyperactivity disorder, combined type Attention-deficit hyperactivity disorder, combined type |
| F90.8 | hyperactivity disorder, other type Attention-deficit hyperactivity disorder, other type |
| F90.9 | hyperactivity disorder, unspecified type Attention-deficit hyperactivity disorder, unspecified type |
| F91.1 | disorder, childhood-onset type Conduct disorder, childhood-onset type |
| F91.2 | disorder, adolescent-onset type Conduct disorder, adolescent-onset type |
| F91.3 | defiant disorder Oppositional defiant disorder |
| F91.8 | conduct disorders Other conduct disorders |
| F91.9 | disorder, unspecified Conduct disorder, unspecified |
| F93.0 | anxiety disorder of childhood Separation anxiety disorder of childhood |
| F93.8 | childhood emotional disorders Other childhood emotional disorders |
| F93.9 | emotional disorder, unspecified Childhood emotional disorder, unspecified |
| F94.0 | mutism Selective mutism |
| F94.1 | attachment disorder of childhood Reactive attachment disorder of childhood |
| F94.8 | childhood disorders of social functioning Other childhood disorders of social functioning |
| F95.0 | tic disorder Transient tic disorder |
| F95.1 | motor or vocal tic disorder Chronic motor or vocal tic disorder |
| F95.2 | disorder Tourette's disorder |
| F95.9 | disorder, unspecified Tic disorder, unspecified |
| F98.0 | not due to a substance or known physiol condition Enuresis not due to a substance or known physiological condition |
| F98.1 | not due to a substance or known physiol condition Encopresis not due to a substance or known physiological condition |
| F98.21 | disorder of infancy Rumination disorder of infancy |
| F98.29 | feeding disorders of infancy and early childhood Other feeding disorders of infancy and early childhood |
| F98.3 | of infancy and childhood Pica of infancy and childhood |
| F98.4 | movement disorders Stereotyped movement disorders |
| F98.5 | onset fluency disorder Adult onset fluency disorder |
| F98.8 | behav/emotn disord w onset usly occur in chldhd and adol Other specified behavioral and emotional disorders with onset usually occurring in childhood and adolescence |
| F98.9 | behav/emotn disord w onst usly occur in chldhd and adol Unspecified behavioral and emotional disorders with onset usually occurring in childhood and adolescence |
| F99 | disorder, not otherwise specified Mental disorder, not otherwise specified |
| G44.209 | headache, unspecified, not intractable Tension-type headache, unspecified, not intractable |
| H93.25 | auditory processing disorder Central auditory processing disorder |
| R37 | dysfunction, unspecified Sexual dysfunction, unspecified |
| R45.1 | and agitation Restlessness and agitation |
| R45.7 | of emotional shock and stress, unspecified State of emotional shock and stress, unspecified |
| R48.0 | and alexia Dyslexia and alexia |
| Z87.890 | history of sex reassignment Personal history of sex reassignment |
| ICD-10 CM | Description |
| F32.81 | Premenstrual dysphoric disorder |
| F32.89 | Other specified depressive episodes |
| F34.81 | Disruptive mood dysregulation disorder |
| F34.89 | Other specified persistent mood disorders |
| F42.2 | Mixed obsessional thoughts and acts |
| F42.3 | Hoarding disorder |
| F42.4 | Excoriation (skin-picking) disorder |
| F42.8 | Other obsessive-compulsive disorder |
| F64.0 | Transsexualism |
| F64.1 | Dual role transvestism |
| F50.81 | Binge eating disorder |
| F50.89 | Other specified eating disorder |
| F80.82 | Social pragmatic communication disorder |
| Date | Action | Description |
|---|---|---|
| 07/03/2025 | Policy Retired | Payment standard will be followed instead of policy |
| 12/29/2017 | ||
| 09/16/2016 | ICD-10 CM | Added ICD-10 CM |
| 05/11/2016 | ||
| 05/20/2013 | ||
| 06/03/2009 | iCES | |
| 08/29/2007 | ||
| 12/20/2004 | ||
| 06/07/1995 | Created | New policy, |