Attention Deficit Hyperactivity Disorder Assessment and Treatment Policy Update - Effective 10/1/20

Date: 08/12/20

Superior HealthPlan will be incorporating revisions to its Attention Deficit Hyperactivity Disorder Assessment and Treatment Policy. For details and applicable requirements related to the proposed policy revision, please review the policy linked in the table below for each applicable product.

Policy Number/Name	Effective Date	Applicable Products	New Policy Overview or Updated Policy Revisions	Policy Link
TX.CP.MP.124 Attention Deficit Hyperactivity Disorder Assessment and Treatment	10/01/20	Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS) CHIP, Allwell from Superior HealthPlan (HMO and HMO SNP) and Ambetter from Superior HealthPlan (Marketplace)	Various policy updates, to include: Adoption of applicable 2019 American Academy of Pediatrics (AAP) Clinical Practice Guidelines for ADHD; and Added information regarding The Society for Developmental and Behavioral Pediatrics (SDBP) Clinical Practice Guidelines and Process of Care Algorithms for Assessment and Treatment of Children and Adolescents with Complex ADHD; and Updated Background section to include most recent prevalent statistics and the necessity of treatment by Primary Care Providers. CPT Code Updates: Removed 78607, 95827, 97127 Added: 78803, 81171, 81172, 92065, 92547, 95705, 95706, 95707, 95708, 95709, 95710, 95711, 95712, 95713, 95714, 95715, 95716, 95717, 95718, 95719, 95720, 95721, 95722, 95723, 95724, 95725, 95726, 96121, 97129, 97130 HCPCS Code Updates: Added: G0176	Attention Deficit Hyperactivity Disorder Assessment and Treatment (TX.CP.MP.124)

Policy Number/Name

Effective Date

Applicable Products

New Policy Overview or Updated Policy Revisions

Policy Link

TX.CP.MP.124

Attention Deficit Hyperactivity Disorder Assessment and Treatment

10/01/20

Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS) CHIP, Allwell from Superior HealthPlan (HMO and HMO SNP) and Ambetter from Superior HealthPlan (Marketplace)

Various policy updates, to include:

Adoption of applicable 2019 American Academy of Pediatrics (AAP) Clinical Practice Guidelines for ADHD; and
Added information regarding The Society for Developmental and Behavioral Pediatrics (SDBP) Clinical Practice Guidelines and Process of Care Algorithms for Assessment and Treatment of Children and Adolescents with Complex ADHD; and
Updated Background section to include most recent prevalent statistics and the necessity of treatment by Primary Care Providers.

CPT Code Updates:

Removed 78607, 95827, 97127
Added: 78803, 81171, 81172, 92065, 92547, 95705, 95706, 95707, 95708, 95709, 95710, 95711, 95712, 95713, 95714, 95715, 95716, 95717, 95718, 95719, 95720, 95721, 95722, 95723, 95724, 95725, 95726, 96121, 97129, 97130

HCPCS Code Updates:

Added: G0176

Attention Deficit Hyperactivity Disorder Assessment and Treatment (TX.CP.MP.124)

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

For questions or additional information, please contact your local Account Manager.