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.

Anorexia Nervosa

Attention-Deficit/Hyperactivity Disorder (ADHD)

Autism Spectrum Disorders and Intensive Behavior Therapy

Binge Eating Disorder

Bipolar and Related Disorders

Bulimia Nervosa

Conduct Disorders

Custodial Care and Inpatient & Residential Services

Depressive Disorders (MDD, PDD, PMDD)

Dissociative Identity Disorders (DID)

Electroconvulsive Therapy (ECT)

Extended Outpatient Sessions

Gambling Disorder

Generalized Anxiety Disorder (GAD)

Health & Behavior Assessment and Intervention

Home-Based Outpatient Treatment

Impulse Control Disorders

Intellectual Disability (Mental Retardation)

Judicial or Administrative Proceedings or Orders (aka Court Ordered Treatment)

Major and Minor Neurocognitive Disorders (Dementia)

Methadone Maintenance

Motor Disorders

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)

Panic Disorder

Personality Disorders

Post-Traumatic Stress Disorder (PTSD)

Proven and Unproven Services

Psychological and Neuropsychological Testing

Reactive Attachment Disorder (RAD)

Schizophrenia and Schizoaffective Disorder

School-Based Services for Children and Adolescents

Specific Learning Disorders

Specific Phobias

Substance-Related Disorders


Transcranial Magnetic Stimulation (TMS)