INDIANA HEALTH COVERAGE PROGRAMS

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1 INDIANA HEALTH COVERAGE PROGRAMS PROVIDER CODE TABLES Division of Mental Health and Addiction (DMHA) Behavioral and Primary Healthcare Coordination (BPHC) Codes Note: Due to possible changes in Indiana Health Coverage Programs (IHCP) policy or national coding updates, inclusion of a code on the code tables does not necessarily indicate current coverage. See IHCP Banner Pages and Bulletins and the IHCP Fee Schedule for updates to coding, coverage, and benefit information. Previous versions of code tables are archived for purposes of historical reference. For information about using this code table, see the Division of Mental Health and Addiction Behavioral and Primary Healthcare Coordination Services provider reference module. F10.10 Yes Alcohol abuse, uncomplicated F Yes Alcohol abuse with intoxication, uncomplicated F Yes Alcohol abuse with alcohol-induced psychotic disorder with delusions F Yes Alcohol abuse with alcohol-induced psychotic disorder with hallucinations F Yes Alcohol abuse with other alcohol-induced disorder F10.19 Yes Alcohol abuse with unspecified alcohol-induced disorder F10.20 Yes Alcohol dependence, uncomplicated F10.21 Yes Alcohol dependence, in remission F Yes Alcohol dependence with intoxication, uncomplicated F Yes Alcohol dependence with withdrawal, uncomplicated F Yes Alcohol dependence with alcohol-induced psychotic disorder with delusions F Yes Alcohol dependence with alcohol-induced psychotic disorder with hallucinations F10.29 Yes Alcohol dependence with unspecified alcohol-induced disorder F11.10 Yes Opioid abuse, uncomplicated F Yes Opioid abuse with intoxication, uncomplicated F Yes Opioid abuse with opioid-induced psychotic disorder with delusions F Yes Opioid abuse with opioid-induced psychotic disorder, with hallucinations 1 Adult Needs and Strengths Assessment. Published: October 26,

2 F Yes Opioid abuse with opioid-induced psychotic disorder, unspecified F11.19 Yes Opioid abuse with unspecified opioid-induced disorder F11.20 Yes Opioid dependence, uncomplicated F11.21 Yes Opioid dependence in remission F Yes Opioid dependence with intoxication, uncomplicated F Yes Opioid dependence with opioid-induced psychotic disorder with delusions F Yes Opioid dependence with opioid-induced psychotic disorder with hallucinations F Yes Opioid dependence with opioid-induced psychotic disorder, unspecified F11.29 Yes Opioid dependence with unspecified opioid-induced disorder F12.10 Yes Cannabis abuse, uncomplicated F Yes Cannabis abuse with intoxication, uncomplicated F Yes Cannabis abuse with psychotic disorder with delusions F Yes Cannabis abuse with psychotic disorder with hallucinations F12.19 Yes Cannabis abuse with unspecified cannabis-induced disorder F12.20 Yes Cannabis dependence, uncomplicated F12.21 Yes Cannabis dependence, in remission F Yes Cannabis dependence with intoxication, uncomplicated F Yes Cannabis dependence with psychotic disorder with delusions F Yes Cannabis dependence with psychotic disorder with hallucinations F12.29 Yes Cannabis dependence with unspecified cannabis-induced disorder F13.10 Yes Sedative, hypnotic or anxiolytic abuse, uncomplicated F Yes Sedative, hypnotic or anxiolytic abuse with intoxication, uncomplicated F Yes Sedative, hypnotic or anxiolytic abuse with sedative, hypnotic or anxiolytic-induced psychotic disorder with delusions F Yes Sedative, hypnotic or anxiolytic abuse with sedative, hypnotic or anxiolytic-induced psychotic disorder with hallucinations F Yes Sedative, hypnotic or anxiolytic abuse with other sedative, hypnotic or anxiolyticinduced disorder F13.19 Yes Sedative, hypnotic or anxiolytic abuse with unspecified sedative, hypnotic or anxiolytic-induced disorder F13.20 Yes Sedative, hypnotic or anxiolytic dependence, uncomplicated F13.21 Yes Sedative, hypnotic or anxiolytic dependence, in remission F Yes Sedative, hypnotic or anxiolytic dependence with intoxication, uncomplicated F Yes Sedative, hypnotic or anxiolytic dependence with withdrawal, uncomplicated F Yes Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolyticinduced psychotic disorder with delusions F Yes Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolyticinduced psychotic disorder with hallucinations Published: October 26,

3 F13.26 Yes Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolyticinduced persisting amnestic disorder F13.29 Yes Sedative, hypnotic or anxiolytic dependence with unspecified sedative, hypnotic or anxiolytic-induced disorder F14.10 Yes Cocaine abuse, uncomplicated F Yes Cocaine abuse with intoxication, uncomplicated F Yes Cocaine abuse with cocaine-induced psychotic disorder with delusions F Yes Cocaine abuse with cocaine-induced psychotic disorder with hallucinations F14.19 Yes Cocaine abuse with unspecified cocaine-induced disorder F14.20 Yes Cocaine dependence, uncomplicated F14.21 Yes Cocaine dependence, in remission F Yes Cocaine dependence with intoxication, uncomplicated F Yes Cocaine dependence with cocaine-induced psychotic disorder with delusions F Yes Cocaine dependence with cocaine-induced psychotic disorder with hallucinations F14.29 Yes Cocaine dependence with unspecified cocaine-induced disorder F15.10 Yes Other stimulant abuse, uncomplicated F Yes Other stimulant abuse with intoxication, uncomplicated F15.19 Yes Other stimulant abuse with unspecified stimulant-induced disorder F15.20 Yes Other stimulant dependence, uncomplicated F15.21 Yes Other stimulant dependence, in remission F Yes Other stimulant dependence with intoxication, uncomplicated F15.29 Yes Other stimulant dependence with unspecified stimulant-induced disorder F16.10 Yes Hallucinogen abuse, uncomplicated F Yes Hallucinogen abuse with intoxication, uncomplicated F Yes Hallucinogen abuse with hallucinogen persisting perception disorder (flashbacks) F Yes Hallucinogen abuse with other hallucinogen-induced disorder F16.19 Yes Hallucinogen abuse with unspecified hallucinogen-induced disorder F16.20 Yes Hallucinogen dependence, uncomplicated F16.21 Yes Hallucinogen dependence, in remission F Yes Hallucinogen dependence with intoxication, uncomplicated F Yes Hallucinogen dependence with hallucinogen-induced psychotic disorder with delusions F Yes Hallucinogen dependence with hallucinogen-induced psychotic disorder with hallucinations F Yes Hallucinogen dependence with hallucinogen persisting perception disorder (flashbacks) F Yes Hallucinogen dependence with other hallucinogen-induced disorder F16.29 Yes Hallucinogen dependence with unspecified hallucinogen-induced disorder Published: October 26,

4 F18.10 Yes Inhalant abuse, uncomplicated F Yes Inhalant abuse with intoxication, uncomplicated F Yes Inhalant abuse with inhalant-induced psychotic disorder with delusions F Yes Inhalant abuse with inhalant-induced psychotic disorder with hallucinations F18.19 Yes Inhalant abuse with unspecified inhalant-induced disorder F18.20 Yes Inhalant dependence, uncomplicated F18.21 Yes Inhalant dependence, in remission F Yes Inhalant dependence with intoxication, uncomplicated F Yes Inhalant dependence with inhalant-induced psychotic disorder with delusions F Yes Inhalant dependence with inhalant-induced psychotic disorder with hallucinations F18.29 Yes Inhalant dependence with unspecified inhalant-induced disorder F19.10 Yes Other psychoactive substance abuse, uncomplicated F Yes Other psychoactive substance abuse with intoxication, uncomplicated F Yes Other psychoactive substance abuse with intoxication with perceptual disturbances F Yes Other psychoactive substance abuse with psychoactive substance-induced psychotic disorder with delusions F Yes Other psychoactive substance abuse with psychoactive substance-induced psychotic disorder with hallucinations F19.16 Yes Other psychoactive substance abuse with psychoactive substance-induced persisting amnestic disorder F19.19 Yes Other psychoactive substance abuse with unspecified psychoactive substanceinduced disorder F19.20 Yes Other psychoactive substance dependence, uncomplicated F19.21 Yes Other psychoactive substance dependence, in remission F Yes Other psychoactive substance dependence with intoxication, uncomplicated F Yes Other psychoactive substance dependence with intoxication with perceptual disturbance F Yes Other psychoactive substance dependence with withdrawal, uncomplicated F Yes Other psychoactive substance dependence with withdrawal with perceptual disturbance F Yes Other psychoactive substance dependence with psychoactive substance-induced psychotic disorder with delusions F Yes Other psychoactive substance dependence with psychoactive substance-induced psychotic disorder with hallucinations F19.26 Yes Other psychoactive substance dependence with psychoactive substance-induced persisting amnestic disorder F19.29 Yes Other psychoactive substance dependence with unspecified psychoactive substanceinduced disorder F20.0 Yes Paranoid schizophrenia Published: October 26,

5 F20.1 Yes Disorganized schizophrenia F20.2 Yes Catatonic schizophrenia F20.3 Yes Undifferentiated schizophrenia F20.5 Yes Residual schizophrenia F20.81 Yes Schizophreniform disorder F20.89 Yes Other schizophrenia F20.9 Yes Schizophrenia, unspecified F22 Yes Delusional disorders F24 Yes Shared psychotic disorder F25.0 Yes Schizoaffective disorder, bipolar type F25.1 Yes Schizoaffective disorder, depressive type F25.8 Yes Other schizoaffective disorders F25.9 Yes Schizoaffective disorder, unspecified F28 Yes Other psychotic disorder not due to a substance or known physiological condition F29 Yes Unspecified psychosis not due to a substance or known physiological condition F30.10 Yes Manic episode without psychotic symptoms, unspecified F30.12 Yes Manic episode without psychotic symptoms, moderate F30.13 Yes Manic episode, severe, without psychotic symptoms F30.2 Yes Manic episode, severe with psychotic symptoms F30.3 Yes Manic episode in partial remission F30.9 Yes Manic episode, unspecified F31.0 Yes Bipolar disorder, current episode hypomanic F31.10 Yes Bipolar disorder, current episode manic without psychotic features, unspecified F31.12 Yes Bipolar disorder, current episode manic without psychotic features, moderate F31.13 Yes Bipolar disorder, current episode manic without psychotic features, severe F31.2 Yes Bipolar disorder, current episode manic severe with psychotic features F31.30 Yes Bipolar disorder, current episode depressed, mild or moderate severity, unspecified F31.32 Yes Bipolar disorder, current episode depressed, moderate F31.4 Yes Bipolar disorder, current episode depressed, severe, without psychotic features F31.5 Yes Bipolar disorder, current episode depressed, severe, with psychotic features F31.60 Yes Bipolar disorder, current episode mixed, unspecified F31.62 Yes Bipolar disorder, current episode mixed, moderate F31.63 Yes Bipolar disorder, current episode mixed, severe, without psychotic features F31.64 Yes Bipolar disorder, current episode mixed, severe, with psychotic features F31.71 Yes Bipolar disorder, in partial remission, most recent episode hypomanic F31.73 Yes Bipolar disorder, in partial remission, most recent episode manic Published: October 26,

6 F31.75 Yes Bipolar disorder, in partial remission, most recent episode depressed F31.77 Yes Bipolar disorder, in partial remission, most recent episode mixed F31.81 Yes Bipolar II disorder F31.89 Yes Other bipolar disorder F31.9 Yes Bipolar disorder, unspecified F32.1 Yes Major depressive disorder, single episode, moderate F32.2 Yes Major depressive disorder, single episode, severe without psychotic features F32.3 Yes Major depressive disorder, single episode, severe with psychotic features F32.4 Yes Major depressive disorder, single episode, in partial remission F33.1 Yes Major depressive disorder, recurrent, moderate F33.2 Yes Major depressive disorder, recurrent severe without psychotic features F33.3 Yes Major depressive disorder, recurrent, severe with psychotic symptoms F33.41 Yes Major depressive disorder, recurrent, in partial remission F33.9 Yes Major depressive disorder, recurrent, unspecified F34.0 Yes Cyclothymic disorder F34.1 Yes Dysthymic disorder F40.00 Yes Agoraphobia, unspecified F40.01 Yes Agoraphobia with panic disorder F40.02 Yes Agoraphobia without panic disorder F40.10 Yes Social phobia, unspecified F41.0 Yes Panic disorder [episodic paroxysmal anxiety] F41.1 Yes Generalized anxiety disorder F42.2 Yes Mixed obsessional thoughts and acts F42.3 Yes Hoarding disorder F43.10 Yes Post-traumatic stress disorder, unspecified F43.11 Yes Post-traumatic stress disorder, acute F43.12 Yes Post-traumatic stress disorder, chronic F44.81 Yes Dissociative identity disorder F45.41 Yes Pain disorder exclusively related to psychological factors F50.00 Yes Anorexia nervosa, unspecified F50.01 Yes Anorexia nervosa, restricting type F50.02 Yes Anorexia nervosa, binge eating/purging type F50.2 Yes Bulimia nervosa F50.82 Yes Avoidant/restrictive food intake disorder F50.9 Yes Eating disorder, unspecified F51.4 Yes Sleep terrors [night terrors] Published: October 26,

7 F60.0 Yes Paranoid personality disorder F60.3 Yes Borderline personality disorder Table Revision History October 1, 2017, update: Added (effective October 1, 2017): F50.82 Updated description (effective October 1, 2017): F41.0 November 10, 2016, update: Removed (effective November 10, 2016): F42.8 October 1, 2016, update: Added (effective October 1, 2016): F42.2, F42.3, F42.8 Removed (effective October 1, 2016): F42, F50.8 March 2, 2016, update: Removed (effective March 2, 2016): F32.9 Published: October 26,

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