Our Coverage Determination Guidelines are intended to standardize the interpretation and application of terms of the Member's Benefit Plan including terms of coverage, Benefit Plan exclusions and limitations.
Attention-Deficit/Hyperactivity Disorder (ADHD)
Autism Spectrum Disorders and Intensive Behavior Therapy
Custodial Care and Inpatient & Residential Services
Depressive Disorders (MDD, PDD, PMDD)
Dissociative Identity Disorders (DID)
Electroconvulsive Therapy (ECT)
Generalized Anxiety Disorder (GAD)
Health & Behavior Assessment and Intervention
Home-Based Outpatient Treatment
Intellectual Disability (Mental Retardation)
Judicial or Administrative Proceedings or Orders (aka Court Ordered Treatment)
Major and Minor Neurocognitive Disorders (Dementia)
Obsessive Compulsive Disorder (OCD)
Opioid Dependence, Ambulatory Treatment of
Oppositional Defiant Disorder (ODD)
Other Conditions That May Be a Focus of Clinical Attention (V-Codes)
Post-Traumatic Stress Disorder (PTSD)
Psychological and Neuropsychological Testing
Reactive Attachment Disorder (RAD)
Schizophrenia and Schizoaffective Disorder