ADHD uses ICD-10 F90.0 (predominantly inattentive), F90.1 (predominantly hyperactive-impulsive), or F90.2 (combined). Initial evaluation billed as 90791 (psychiatric evaluation without medical services) or 90792 (with medical services) or as E/M visit (99213-99215). Medication management uses E/M codes 99213-99215, with time spent on medication review counting toward level. Psychological testing codes 96130-96133 cover ADHD-specific assessment when billed with evaluation using modifier 25.
Always specify ADHD subtype in diagnosis coding (inattentive, hyperactive-impulsive, combined). Bill psychiatric evaluation (90791/90792) for comprehensive diagnostic workup. Medication management is billed as E/M; time spent reviewing medications, side effects, and dosage adjustments counts toward E/M level. Psychological testing (96130-96133) can be billed with evaluation on same date using modifier 25. Do not bill psychotherapy codes and psychiatric evaluation on the same date without modifier 25 on the E/M.
Most payers require prior authorization for ADHD evaluation and medication management. Some plans limit psychiatric evaluation frequency (e.g., once per year for medication management). Psychological testing may require separate authorization. Medications (stimulants, atomoxetine, guanfacine, clonidine) are controlled by pharmacy formulary restrictions, not medical coding. Verify coverage for psychiatric evaluation and testing before billing.
Use modifier 25 if billing psychotherapy (90834, 90837) along with psychiatric evaluation or E/M on the same date. Modifier 26 applies to psychological testing professional component if billed separately from facility component. Do not bill psychiatric evaluation codes multiple times on the same date without documentation of distinct evaluation components. E/M and psychotherapy on the same date require modifier 25 on the E/M code.
Document patient and family history of ADHD, childhood onset of symptoms, school or work impairment, and current functioning. Include DSM-5 diagnostic criteria met (inattention, hyperactivity-impulsivity, functional impairment). Document medications reviewed or prescribed, dosages, side effects, and clinical response. Include objective testing results when available. Medication management visits require documentation of medication efficacy, compliance, and any adjustments.
F90.0 = predominantly inattentive type; F90.1 = predominantly hyperactive-impulsive type; F90.2 = combined presentation. Specify the subtype in all diagnoses.
Use 90791 (psychiatric evaluation without medical services) or 90792 (with medical services). Alternately, bill as an E/M visit (99213-99215) if conducted in that format.
Use E/M codes 99213-99215. Time spent discussing medications counts toward E/M level. Document medications reviewed, changes made, side effects assessed, and clinical rationale.
Altair validates behavioral health coding and compliance rules before submission. See how it works.
View Altair