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ICD-10 COVERED DIAGNOSES TABLE
EFFECTIVE OCTOBER 1, 2019 THROUGH SEPTEMBER 30, 2020
Enclosure 1
Press TAB Diagnosis Code Diagnosis Description
F01.51 Vascular Dementia With Behavioral Disturbance F10.14 Alcohol Abuse With Alcohol-Induced Mood Disorder F10.150 Alcohol Abuse With Alcohol-Induced Psychotic Disorder With Delusions F10.151 Alcohol Abuse With Alcohol-Induced Psychotic Disorder With Hallucinations F10.159 Alcohol abuse with alcohol-induced psychotic disorder, unspecified F10.180 Alcohol Abuse With Alcohol-Induced Anxiety Disorder F10.24 Alcohol Dependence With Alcohol-Induced Mood Disorder F10.250 Alcohol Dependence With Alcohol-Induced Psychotic Disorder With Delusions F10.251 Alcohol Dependence With Alcohol-Induced Psychotic Disorder With Hallucinations F10.259 Alcohol dependence with alcohol-induced psychotic disorder, unspecified F10.280 Alcohol Dependence With Alcohol-Induced Anxiety Disorder F10.94 Alcohol Use, Unspecified, With Alcohol-Induced Mood Disorder F10.950 Alcohol Use, Unspecified, With Alcohol-Induced Psychotic Disorder With Delusions
F10.951 Alcohol Use, Unspecified, With Alcohol-Induced Psychotic Disorder With Hallucinations
F10.959 Alcohol use, unspecified with alcohol-induced psychotic disorder, unspecified F10.980 Alcohol use, unspecified with alcohol-induced anxiety disorder F11.14 Opioid Abuse With Opioid-Induced Mood Disorder F11.150 Opioid Abuse With Opioid-Induced Psychotic Disorder With Delusions F11.151 Opioid Abuse With Opioid-Induced Psychotic Disorder With Hallucinations F11.159 Opioid abuse with opioid-induced psychotic disorder, unspecified F11.24 Opioid Dependence With Opioid-Induced Mood Disorder F11.250 Opioid Dependence With Opioid-Induced Psychotic Disorder With Delusions F11.251 Opioid Dependence With Opioid-Induced Psychotic Disorder With Hallucinations F11.259 Opioid dependence with opioid-induced psychotic disorder, unspecified F11.94 Opioid Use, Unspecified, With Opioid-Induced Mood Disorder F11.950 Opioid Use, Unspecified, With Opioid-Induced Psychotic Disorder With Delusions
F11.951 Opioid Use, Unspecified, With Opioid-Induced Psychotic Disorder With Hallucinations
F11.959 Opioid use, unspecified with opioid-induced psychotic disorder, unspecified F11.988 Opioid-Induced Anxiety Disorder Without Opioid Use Disorder F12.150 Cannabis Abuse With Psychotic Disorder With Delusions F12.151 Cannabis Abuse With Cannabis-Induced Psychotic Disorder With Hallucinations F12.159 Cannabis abuse with psychotic disorder, unspecified F12.180 Cannabis Abuse With Cannabis-Induced Anxiety Disorder F12.250 Cannabis Dependence With Psychotic Disorder With Delusions
F12.251 Cannabis Dependence With Cannabis-Induced Psychotic Disorder With Hallucinations
F12.259 Cannabis dependence with psychotic disorder, unspecified F12.280 Cannabis Dependence With Cannabis-Induced Anxiety Disorder F12.950 Cannabis Use, Unspecified, With Psychotic Disorder With Delusions
F12. Cannabis Use, Unspecified, With Cannabis-Induced Psychotic Disorder With Hallucinations F12.959 Cannabis use, unspecified with psychotic disorder, unspecified F12.980 Cannabis Use, Unspecified, With Cannabis-Induced Anxiety Disorder
ICD-10 COVERED DIAGNOSES TABLE
EFFECTIVE OCTOBER 1, 2019 THROUGH SEPTEMBER 30, 2020
Enclosure 1
Diagnosis Code Diagnosis Description
F13. Sedative, Hypnotic or Anxiolytic Abuse with Sedative-, Hypnotic-, or Anxiolytic-Induced Mood Disorder
F13. Sedative, Hypnotic, or Anxiolytic Abuse with Sedative-, Hypnotic-, or Anxiolytic-Induced Psychotic Disorder With Delusions
F13. Sedative, Hypnotic, or Anxiolytic Abuse With Sedative-, Hypnotic-, or Anxiolytic-Induced Psychotic Disorder With Hallucinations
F13. Sedative, hypnotic or anxiolytic abuse with sedative, hypnotic or anxiolytic-induced psychotic disorder, unspecified
F13. Sedative, Hypnotic or Anxiolytic Abuse With Sedative-, Hypnotic-, or Anxiolytic-Induced Anxiety Disorder
F13.24 Sedative, Hypnotic or Anxiolytic Dependence With Sedative-, Hypnotic-, or Anxiolytic- Induced Mood Disorder
F13. Sedative, Hypnotic, or Anxiolytic Dependence With Sedative-, Hypnotic-, or Anxiolytic- Induced Psychotic Disorder With Delusions
F13. Sedative, Hypnotic, or Anxiolytic Dependence With Sedative-, Hypnotic-, or Anxiolytic- Induced Psychotic Disorder with Hallucinations
F13. Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced psychotic disorder, unspecified
F13. Sedative, Hypnotic or Anxiolytic Dependence With Sedative-, Hypnotic-, or Anxiolytic- Induced Anxiety Disorder
F13. Sedative, Hypnotic or Anxiolytic Use, Unspecified, With Sedative-, Hypnotic-, or Anxiolytic- Induced Mood Disorder
F13.950 Sedative, Hypnotic, or Anxiolytic Use, Unspecified, With Sedative-, Hypnotic-, or Anxiolytic-Induced Psychotic Disorder With Delusions
F13.951 Sedative, Hypnotic, or Anxiolytic Use, Unspecified, With Sedative-, Hypnotic-, or Anxiolytic-Induced Psychotic Disorder With Hallucinations
F13. Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic- induced psychotic disorder, unspecified
F13. Sedative, Hypnotic or Anxiolytic Use, Unspecified, With Sedative-, Hypnotic-, or Anxiolytic- Induced Anxiety Disorder F14.14 Cocaine Abuse With Cocaine-Induced Mood Disorder F14.150 Cocaine Abuse With Cocaine-Induced Psychotic Disorder With Delusions F14.151 Cocaine Abuse With Cocaine-Induced Psychotic Disorder With Hallucinations F14.159 Cocaine abuse with cocaine-induced psychotic disorder, unspecified F14.180 Cocaine Abuse With Cocaine-Induced Anxiety Disorder F14.24 Cocaine Dependence With Cocaine-Induced Mood Disorder F14.250 Cocaine Dependence With Cocaine-Induced Psychotic Disorder With Delusions F14.251 Cocaine Dependence With Cocaine-Induced Psychotic Disorder With Hallucinations F14.259 Cocaine dependence with cocaine-induced psychotic disorder, unspecified F14.280 Cocaine Dependence With Cocaine-Induced Anxiety Disorder F14.94 Cocaine Use, Unspecified, With Cocaine-Induced Mood Disorder F14.950 Cocaine Use, Unspecified, With Cocaine-Induced Psychotic Disorder With Delusions
F14.951 Cocaine Use, Unspecified, With Cocaine-Induced Psychotic Disorder With Hallucinations
F14.959 Cocaine use, unspecified with cocaine-induced psychotic disorder, unspecified
ICD-10 COVERED DIAGNOSES TABLE
EFFECTIVE OCTOBER 1, 2019 THROUGH SEPTEMBER 30, 2020
Enclosure 1
Diagnosis Code Diagnosis Description
F16. Hallucinogen Use, Unspecified, With Hallucinogen Persisting Perception Disorder (Flashbacks) F18.14 Inhalant Abuse With Inhalant-Induced Mood Disorder F18.150 Inhalant Abuse With Inhalant-Induced Psychotic Disorder With Delusions F18.151 Inhalant Abuse With Inhalant-Induced Psychotic Disorder With Hallucinations F18.159 Inhalant abuse with inhalant-induced psychotic disorder, unspecified F18.180 Inhalant Abuse With Inhalant-Induced Anxiety Disorder F18.24 Inhalant Dependence With Inhalant-Induced Mood Disorder F18.250 Inhalant Dependence With Inhalant-Induced Psychotic Disorder With Delusions F18.251 Inhalant Dependence With Inhalant-Induced Psychotic Disorder With Hallucinations F18.259 Inhalant dependence with inhalant-induced psychotic disorder, unspecified F18.280 Inhalant Dependence With Inhalant-Induced Anxiety Disorder F18.94 Inhalant Use, Unspecified, With Inhalant-Induced Mood Disorder F18.950 Inhalant Use, Unspecified, With Inhalant-Induced Psychotic Disorder With Delusions
F18.951 Inhalant Use, Unspecified, With Inhalant-Induced Psychotic Disorder With Hallucinations
F18.959 Inhalant use, unspecified with inhalant-induced psychotic disorder, unspecified F18.980 Inhalant Use, Unspecified, With Inhalant-Induced Anxiety Disorder
F19. Other Psychoactive Substance Abuse With Psychoactive Substance-Induced Mood Disorder
F19. Other Psychoactive Substance Abuse With Psychoactive Substance-Induced Psychotic Disorder With Delusions
F19.151 Other Psychoactive Substance Abuse With Psychoactive Substance-Induced Psychotic Disorder With Hallucinations
F19.159 Other psychoactive substance abuse with psychoactive substance-induced psychotic disorder, unspecified
F19. Other Psychoactive Substance Abuse With Psychoactive Substance-Induced Anxiety Disorder
F19. Other Psychoactive Substance Dependence With Psychoactive Substance-Induced Mood Disorder
F19. Other Psychoactive Substance Dependence With Psychoactive Substance-Induced Psychotic Disorder With Delusions
F19. Other Psychoactive Substance Dependence With Psychoactive Substance-Induced Psychotic Disorder With Hallucinations
F19.259 Other psychoactive substance dependence with psychoactive substance-induced psychotic disorder, unspecified
F19.280 Other Psychoactive Substance Dependence With Psychoactive Substance-Induced Anxiety Disorder
F19. Other Psychoactive Substance Use, Unspecified, With Psychoactive Substance-Induced Mood Disorder
F19. Other Psychoactive Substance Use, Unspecified, With Psychoactive Substance-Induced Psychotic Disorder With Delusions
F19. Other Psychoactive Substance Use, Unspecified, With Psychoactive Substance-Induced Psychotic Disorder With Hallucinations
ICD-10 COVERED DIAGNOSES TABLE
EFFECTIVE OCTOBER 1, 2019 THROUGH SEPTEMBER 30, 2020
Enclosure 1
Diagnosis Code Diagnosis Description
F19. Other psychoactive substance use, unspecified with psychoactive substance-induced psychotic disorder, unspecified
F19. Other Psychoactive Substance Use, Unspecified, With Psychoactive Substance-Induced Anxiety Disorder F20.0 Paranoid Schizophrenia F20.1 Disorganized Schizophrenia F20.2 Catatonic Schizophrenia F20.3 Undifferentiated Schizophrenia F20.5 Residual Schizophrenia F20.81 Schizophreniform Disorder F20.89 Other Schizophrenia F20.9 Schizophrenia, Unspecified F21 Schizotypal Disorder F22 Delusional Disorders F23 Brief Psychotic Disorder F24 Shared Psychotic Disorder F25.0 Schizoaffective Disorder, Bipolar Type F25.1 Schizoaffective Disorder, Depressive Type F25.8 Other Schizoaffective Disorders F25.9 Schizoaffective Disorder, Unspecified F28 Other Psychotic Disorder Not Due to a Substance or Known Physiological Condition F29 Unspecified Psychosis Not Due to a Substance or Known Physiological Condition F30.10 Manic Episode Without Psychotic Symptoms, Unspecified F30.11 Manic Episode Without Psychotic Symptoms, Mild F30.12 Manic Episode Without Psychotic Symptoms, Moderate F30.13 Manic Episode, Severe, Without Psychotic Symptoms F30.2 Manic Episode, Severe, With Psychotic Symptoms F30.3 Manic Episode in Partial Remission F30.8 Other Manic Episodes F30.9 Manic Episode, Unspecified F31.0 Bipolar Disorder, Current Episode Hypomanic F31.10 Bipolar Disorder, Current Episode Manic Without Psychotic Features, Unspecified F31.11 Bipolar Disorder, Current Episode Manic, Without Psychotic Features, Mild F31.12 Bipolar Disorder, Current Episode Manic, Without Psychotic Features, Moderate F31.13 Bipolar Disorder, Current Episode Manic, Without Psychotic Features, Severe F31.2 Bipolar Disorder, Current Episode Manic, Severe, With Psychotic Features
F31.30 Bipolar Disorder, Current Episode Depressed, Mild or Moderate Severity, Unspecified
F31.31 Bipolar Disorder, Current Episode Depressed, Mild F31.32 Bipolar Disorder, Current Episode Depressed, Moderate F31.4 Bipolar Disorder, Current Episode Depressed, Severe, Without Psychotic Features F31.5 Bipolar Disorder, Current Episode Depressed, Severe, With Psychotic Features F31.60 Bipolar Disorder, Current Episode Mixed, Unspecified F31.61 Bipolar Disorder, Current Episode Mixed, Mild F31.62 Bipolar Disorder, Current Episode Mixed, Moderate
ICD-10 COVERED DIAGNOSES TABLE
EFFECTIVE OCTOBER 1, 2019 THROUGH SEPTEMBER 30, 2020
Enclosure 1
Diagnosis Code Diagnosis Description
F40.248 Other Situational Type Phobia F40.290 Androphobia F40.291 Gynophobia F40.298 Other Specified Phobia F40.8 Other Phobic Anxiety Disorders F41.0 Panic Disorder [Episodic Paroxysmal Anxiety] F41.1 Generalized Anxiety Disorder F41.3 Other Mixed Anxiety Disorders F41.8 Other Specified Anxiety Disorders F41.9 Anxiety Disorder, Unspecified F42.2 Mixed Obsessional Thoughts and Acts F42.3 Hoarding Disorder F42.4 Excoriation Disorder F42.8 Other Obsessive-Compulsive Disorder F42.9 Obsessive-Compulsive Disorder, Unspecified F43.0 Acute Stress Reaction F43.10 Post-Traumatic Stress Disorder, Unspecified F43.11 Post-Traumatic Stress Disorder, Acute F43.12 Post-Traumatic Stress Disorder, Chronic F43.20 Adjustment Disorder, Unspecified F43.21 Adjustment Disorder With Depressed Mood F43.22 Adjustment Disorder With Anxiety F43.23 Adjustment Disorder With Mixed Anxiety and Depressed Mood F43.24 Adjustment Disorder With Disturbance of Conduct F43.25 Adjustment Disorder With Mixed Disturbance of Emotions and Conduct F43.29 Adjustment Disorder with Other Symptoms F43.8 Other Reactions to Severe Stress F43.9 Reaction to Severe Stress, Unspecified F44.0 Dissociative Amnesia F44.1 Dissociative Fugue F44.2 Dissociative Stupor F44.4 Conversion Disorder With Motor Symptom or Deficit F44.5 Conversion Disorder With Seizures or Convulsions F44.6 Conversion Disorder With Sensory Symptom or Deficit F44.7 Conversion Disorder With Mixed Symptom Presentation F44.81 Dissociative Identity Disorder F44.89 Other Dissociative and Conversion Disorders F44.9 Dissociative and Conversion Disorder, Unspecified F45.0 Somatization Disorder F45.1 Undifferentiated Somatoform Disorder F45.20 Hypochondriacal Disorder, Unspecified F45.21 Hypochondriasis F45.22 Body Dysmorphic Disorder F45.29 Other Hypochondriacal Disorders F45.41 Pain Disorder Exclusively Related to Psychological Factors
ICD-10 COVERED DIAGNOSES TABLE
EFFECTIVE OCTOBER 1, 2019 THROUGH SEPTEMBER 30, 2020
Enclosure 1
Diagnosis Code Diagnosis Description
F45.42 Pain Disorder With Related Psychological Factors F45.8 Other Somatoform Disorders F45.9 Somatoform Disorder, Unspecified F48.1 Depersonalization-Derealization Syndrome F50.00 Anorexia Nervosa, Unspecified F50.01 Anorexia Nervosa, Restricting Type F50.02 Anorexia Nervosa, Binge Eating/Purging Type F50.2 Bulimia Nervosa F50.81 Binge Eating Disorder F50.82 Avoidant/Restrictive Food Intake Disorder F50.89 Other Specified Eating Disorder F50.9 Eating Disorder, Unspecified F53.0 Postpartum Depression F53.1 Puerperal Psychosis F60.0 Paranoid Personality Disorder F60.1 Schizoid Personality Disorder F60.2 Antisocial Personality Disorder F60.3 Borderline Personality Disorder F60.4 Histrionic Personality Disorder F60.5 Obsessive Compulsive Personality Disorder F60.6 Avoidant Personality Disorder F60.7 Dependent Personality Disorder F60.81 Narcissistic Personality Disorder F60.9 Personality Disorder, Unspecified F63.1 Pyromania F63.81 Intermittent Explosive Disorder F63.89 Impulse Disorder, Unspecified F84.0 Autistic Disorder (Autism spectrum disorder) F84.2 Rett's Syndrome F84.3 Other Childhood Disintegrative Disorder F84.5 Asperger's Syndrome F84.8 Other Pervasive Developmental Disorder F84.9 Pervasive Developmental Disorder, Unspecified F90.0 Attention-Deficit/Hyperactivity Disorder, Predominantly Inattentive Type F90.1 Attention-Deficit/Hyperactivity Disorder, Predominantly Hyperactive type F90.2 Attention-Deficit/Hyperactivity Disorder, Combined Type F90.8 Attention-Deficit/Hyperactivity Disorder, Other Type F90.9 Attention-Deficit/Hyperactivity Disorder, Unspecified Type F91.1 Conduct Disorder, Childhood-Onset Type F91.2 Conduct Disorder, Adolescent-Onset Type F91.3 Oppositional Defiant Disorder F91.8 Other Conduct Disorder F91.9 Conduct Disorder, Unspecified F93.0 Separation Anxiety Disorder of Childhood F93.8 Other Childhood Emotional Disorders
