Clinical Policy: Attention Deficit Hyperactivity Disorder Assessment and Treatment
Defines medically necessary assessment and treatment services for ADHD and lists assessments/treatments considered to have insufficient evidence (not medically necessary) when requested for assessment or treatment of ADHD. Also lists CPT/HCPCS codes considered not medically necessary when billed with a sole diagnosis of ADHD and provides background and revision history.
Annual review; 'Experimental/investigational' verbiage replaced with 'there is insufficient evidence to support'.
Revised language specifying ECG can be performed only if clinically indicated.
Updated Section I.A. to include 'collection of collateral information' and 'toxicology screen.'
Added many items to the list of services considered insufficient (II.A and II.B) to reflect AAP 2019 guidelines.
Added statements about suggested first-line adult treatments and favoring medication over CBT; added to Background with no impact to criteria.
Revised description of CPT-81229, 92065, 96366, 96367 and 97814.
Approval by BH Clinical Policy Subcommittee noted with Approval Date = 02/22.
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