News

Effective June 1, 2022: Clinical Payment Policy Revision - Attention Deficit Hyperactivity Disorder (ADHD) Assessment and Treatment

Date: 03/04/22

Superior HealthPlan presents a revised payment policy to communicate the medical necessity criteria for the assessment and treatment of Attention Deficit Hyperactivity Disorder (ADHD). As a result, the revised policy has been added, and is posted on Superior’s Clinical, Payment and Pharmacy webpage for review, prior to its implementation:

POLICY	EFFECTIVE DATE	APPLICABLE PRODUCTS	NEW POLICY OVERVIEW OR UPDATED POLICY REVISIONS
Attention Deficit Hyperactivity Disorder (ADHD) Assessment and Treatment (TX.CP.MP.124)	06/01/2022	Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS), CHIP, Health Insurance Marketplace (Ambetter from Superior HealthPlan)	Addition of CPT codes considered not medically necessary when billed with a sole diagnosis of ADHD: 80061 - Lipid panel This panel must include the following: Cholesterol, serum, total (82465) Lipoprotein, direct measurement, high density cholesterol (HDL cholesterol) (83718) Triglycerides (84478) 82465 - Cholesterol, serum or whole blood, total 83718 - Lipoprotein, direct measurement; high density cholesterol (HDL cholesterol) 83719 - Lipoprotein, direct measurement; VLDL cholesterol 83721 - Lipoprotein, direct measurement; LDL cholesterol 83722 - Lipoprotein, direct measurement; small dense LDL cholesterol 84475 - Triglycerides 92650 - Auditory evoked potentials; screening of auditory potential with broadband stimuli, automated analysis 92651 - Auditory evoked potentials; for hearing status determination, broadband stimuli, with interpretation and report 92652 - Auditory evoked potentials; for threshold estimation at multiple frequencies, with interpretation and report 92653 - Auditory evoked potentials; neurodiagnostic, with interpretation and report 93000 - Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report 93005 - Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report 93010 - Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only

POLICY

EFFECTIVE DATE

APPLICABLE PRODUCTS

NEW POLICY OVERVIEW OR UPDATED POLICY REVISIONS

Attention Deficit Hyperactivity Disorder (ADHD) Assessment and Treatment

(TX.CP.MP.124)

06/01/2022

Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS), CHIP, Health Insurance Marketplace (Ambetter from Superior HealthPlan)

Addition of CPT codes considered not medically necessary when billed with a sole diagnosis of ADHD:

80061 - Lipid panel This panel must include the following: Cholesterol, serum, total (82465) Lipoprotein, direct measurement, high density cholesterol (HDL cholesterol) (83718) Triglycerides (84478)
82465 - Cholesterol, serum or whole blood, total
83718 - Lipoprotein, direct measurement; high density cholesterol (HDL cholesterol)
83719 - Lipoprotein, direct measurement; VLDL cholesterol
83721 - Lipoprotein, direct measurement; LDL cholesterol
83722 - Lipoprotein, direct measurement; small dense LDL cholesterol
84475 - Triglycerides
92650 - Auditory evoked potentials; screening of auditory potential with broadband stimuli, automated analysis
92651 - Auditory evoked potentials; for hearing status determination, broadband stimuli, with interpretation and report
92652 - Auditory evoked potentials; for threshold estimation at multiple frequencies, with interpretation and report
92653 - Auditory evoked potentials; neurodiagnostic, with interpretation and report
93000 - Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report
93005 - Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report
93010 - Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only

To review all payment policies, please visit Superior’s Clinical, Payment and Pharmacy Polices webpage.

For questions or additional information, please contact Superior Provider Services at:

1-877-391-5921 Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS), CHIP
1-877-687-1196 Health Insurance Marketplace (Ambetter from Superior HealthPlan)