Behavioral Health Diagnoses Not Subject to Visit Limits for Most HMSA Plans ICD-9 295.10 Schizophrenia, disorganized type 295.11 N/A Disorganized type schizophrenia, state Disorganized type schizophrenia, subchronic state 295.12 N/A Disorganized type schizophrenia, chronic state 295.13 N/A 295.14 N/A Disorganized type schizophrenia, subchronic state Disorganized type schizophrenia, chronic state 295.15 N/A Disorganized type schizophrenia, in Description F20.1 Disorganized schizophrenia 295.20 Schizophrenia, catatonic type Catatonic type schizophrenia, state 295.21 N/A Catatonic type schizophrenia, subchronic state 295.22 N/A Catatonic type schizophrenia, chronic state 295.23 N/A Catatonic type schizophrenia, subchronic state 295.24 N/A Catatonic type schizophrenia, chronic state 295.25 N/A Catatonic type schizophrenia, in 295.30 Schizophrenia, paranoid type Paranoid type schizophrenia, state F20.2 Catatonic schizophrenia 295.31 N/A Paranoid type schizophrenia, subchronic state 295.32 N/A Paranoid type schizophrenia, chronic state 295.33 N/A Paranoid type schizophrenia, subchronic state 295.34 N/A Paranoid type schizophrenia, chronic state with acute exacerbation 295.35 N/A Paranoid type schizophrenia, in F20.0 Paranoid schizophrenia 1 Behavioral Health Diagnoses Not Subject to Benefit Limits for Most HMSA Plans (updated 09/2015)
295.60 Schizophrenia, residual type 295.61 N/A Schizophrenic disorder, residual type, Schizophrenic disorder, residual type, subchronic 295.62 N/A Schizophrenic disorder, residual type, chronic 295.63 N/A 295.64 N/A 295.65 N/A 295.70 Schizophrenic disorders, residual type, subchronic Schizophrenic disorder, residual type, chronic Schizophrenic disorder, residual type, in 295.91 N/A Unspecified schizophrenia, subchronic state 295.92 N/A Unspecified schizophrenia, chronic state 295.93 N/A Unspecified schizophrenia, subchronic state 295.94 N/A Unspecified schizophrenia, chronic state with acute exacerbation 295.95 N/A Unspecified schizophrenia, in Description F25.0 Schizoaffective disorder, bipolar type F25.1 Schizoaffective disorder, depressive type F25.8 Other schizoaffective disorders F25.9 Schizoaffective disorder, F20.3 Undifferentiated schizophrenia F20.9 Schizophrenia, 296.00 F30.10 F30.9 Manic episode, 296.01 F30.11 296.02 N/A 295.90 Schizophrenia, undifferentiated type Schizoaffective disorder, Unspecified schizophrenia, state F20.5 Residual schizophrenia 295.71 N/A Schizoaffective disorder, subchronic 295.72 N/A Schizoaffective disorder, chronic 295.73 N/A Schizoaffective disorder, subchronic with acute exacerbation F25.9 Schizoaffective disorder, 295.74 N/A Schizoaffective disorder, chronic with acute exacerbation 295.75 N/A Schizoaffective disorder, in F20.9 Schizophrenia, F30.12 2 Behavioral Health Diagnoses Not Subject to Benefit Limits for Most HMSA Plans (updated 09/2015)
Description 296.03 severe, without mention of F30.13 Manic episode, severe, without psychotic 296.04 severe, specified as with 296.05 in in partial partial or 296.06 in full in full 296.10 N/A Manic disorder, recurrent episode, degree F30.2 Manic episode, severe with psychotic F30.3 Manic episode in partial F30.4 Manic episode in full F30.10 296.11 N/A Manic disorder, recurrent episode, degree F30.11 296.12 N/A 296.13 N/A 296.14 N/A 296.15 N/A 296.16 N/A 296.20 296.21 296.22 296.23 296.24 296.25 in partial Manic disorder, recurrent episode, degree Manic disorder, recurrent episode, severe degree, without mention of F30.12 F30.13 Manic episode, severe, without psychotic Manic disorder, recurrent episode, severe Manic episode, severe with psychotic F30.2 degree, specified as with Manic disorder, recurrent episode, in partial or F30.3 Manic episode in partial Manic disorder, recurrent episode, in full F30.4 Manic episode in full F32.9 degree F32.0 degree F32.1 degree severe degree, without mention of psychotic F32.2 severe degree, specified as with psychotic F32.3 in in F32.4 partial or partial 3 Behavioral Health Diagnoses Not Subject to Benefit Limits for Most HMSA Plans (updated 09/2015)
296.26 296.30 296.31 296.32 296.33 296.34 296.35 296.36 296.40 296.41 296.42 296.43 296.44 296.45 296.46 in full Major depressive disorder, single episode in full degree degree severe degree, without mention of psychotic severe degree, specified as with psychotic in partial in partial or in full in full manic, manic, current) manic, manic, current) manic, manic, current) manic, severe, without mention of manic, manic, in partial manic, in full degree current) manic, current) manic, severe, specified as with current) manic, in partial or current) manic, in full F32.5 F33.40 F33.9 Description in full Major depressive disorder, recurrent, in, Major depressive disorder, recurrent, F33.0 Major depressive disorder, recurrent, F33.1 F33.2 F33.3 F33.41 F33.42 Major depressive disorder, recurrent, Major depressive disorder, recurrent severe without psychotic features Major depressive disorder, recurrent, severe with psychotic Major depressive disorder, recurrent, in partial Major depressive disorder, recurrent, in full F31.0 Bipolar disorder, current episode hypomanic F31.10 without psychotic features, F31.89 Other bipolar disorder F31.11 without psychotic features, F31.12 without psychotic features, F31.13 F31.2 F31.73 F31.74 without psychotic features, severe Bipolar disorder, in partial, most recent episode manic Bipolar disorder, in full, most recent episode manic 4 Behavioral Health Diagnoses Not Subject to Benefit Limits for Most HMSA Plans (updated 09/2015)
Description 296.50 depressed, current) depressed, F31.30 or severity, 296.51 296.52 296.53 296.54 296.55 296.56 296.60 296.61 296.62 296.63 296.64 296.65 296.66 depressed, depressed, depressed, depressed, depressed, in partial depressed, in full mixed, mixed, mixed, mixed, mixed, mixed, in partial mixed, in full current) depressed, current) depressed, current) depressed, severe, without mention of current) depressed, severe, specified as with current) depressed, in partial or current) depressed, in full current) mixed, current) mixed, current) mixed, current) mixed, severe, without mention of current) mixed, severe, specified as with current) mixed, in partial or current) mixed, in full F31.31 F31.32 F31.4 F31.5 F31.75 F31.76 F31.60 severe, without psychotic features severe, with psychotic features Bipolar disorder, in partial, most recent episode depressed Bipolar disorder, in full, most recent episode depressed F31.61 F31.62 F31.63 F31.64 F31.77 F31.78 severe, without psychotic features severe, with psychotic features Bipolar disorder, in partial, most recent episode mixed Bipolar disorder, in full, most recent episode mixed 5 Behavioral Health Diagnoses Not Subject to Benefit Limits for Most HMSA Plans (updated 09/2015)
296.7, current) F31.70 F31.71 F31.72 Description Bipolar disorder, currently in, most recent episode Bipolar disorder, in partial, most recent episode hypomanic Bipolar disorder, in full, most recent episode hypomanic F31.9 Bipolar disorder, 296.80 Bipolar disorder NOS Bipolar disorder, F31.9 Bipolar disorder, 296.81 N/A Atypical manic disorder F30.8 Other manic episodes 296.82 N/A Atypical depressive disorder F32.8 Other depressive episodes 296.89 Bipolar II disorder Other and bipolar disorders F31.81 Bipolar II disorder 297.1 Delusional disorder Delusional disorder F22 Delusional disorders 300.12 Dissociative amnesia Dissociative amnesia F44.0 Dissociative amnesia 300.13 Dissociative fugue Dissociative fugue F44.1 Dissociative fugue 300.14 Dissociative identity disorder Dissociative identity disorder F44.81 Dissociative identity disorder 300.15 Dissociative disorder NOS Dissociative disorder or reaction, F44.9 Dissociative and conversion disorder, 300.3 Obsessive-compulsive disorder Obsessive-compulsive disorders F42 Obsessive-compulsive disorder 300.6 Depersonalization disorder Depersonalization disorder F48.1 Depersonalization-derealization syndrome 6 Behavioral Health Diagnoses Not Subject to Benefit Limits for Most HMSA Plans (updated 09/2015)