ADHD Assessment & Treatment Policy (CP.BH.124) Update
Dear Provider,
Thank you for your continued partnership with Meridian. As you know, we continually review and update our payment and utilization policies to ensure that they are designed to comply with industry standards while delivering the best patient experience to our members. We are writing today to inform you of the revision to existing policies Meridian will be implementing effective 08/01/2026.
Policy Number | Policy Name | Policy Description | Lines of Business |
CP.BH.124 | Attention Deficit Hyperactivity Disorder Assessment and Treatment
| Attention deficit hyperactivity disorder (ADHD) is one of the most common neurobehavioral disorders in children, with an increasing prevalence of diagnosis in adults. ADHD affects the cognitive, academic, emotional, and social well-being of individuals and can persist throughout life. While there is no single test to diagnose ADHD, a clinical assessment based on defined clinical parameters establishes criteria for diagnosis in children and adults. | AM Medicaid AM Marketplace
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Policy Updates and Reason
Coding changes bring policy into alignment with other payer policies, LCD, LCA, and American Academy of Child and Adolescent Psychiatry (AACAP) recommendations. Remove the following CPT codes as not payable when only billed with any ICD-10 codes within the following range: F90.0 through F90.9 (Attention-deficit hyperactivity disorders):
- 84437 Thyroxine; requiring elution (eg, neonatal)
- 92569 Deleted Code: Acoustic reflex testing; decay
- 96116 Neurobehavioral status exam (clinical assessment of thinking, reasoning and judgment, [eg, acquired knowledge, attention, language, memory, planning and problem solving, and visual spatial abilities]), by physician or other qualified health care professional, both face-to-face time with the patient and time interpreting test results and preparing the report; first hour
- 96121 Neurobehavioral status exam (clinical assessment of thinking, reasoning and judgment, [eg, acquired knowledge, attention, language, memory, planning and problem solving, and visual spatial abilities]), by physician or other qualified health care professional, both face-to-face time with the patient and time interpreting test results and preparing the report; each additional hour (List separately in addition to code for primary procedure)
Add the following CPT codes as not payable when only billed with any ICD-10 codes within the following range: F90.0 through F90.9:
- 92066 Orthoptic training; under supervision of a physician or other qualified health care professional
- 92545 Oscillating tracking test, with recording
- 92546 Sinusoidal vertical axis rotational testing
- 92548 Computerized dynamic posturography sensory organization test (CDP-SOT), 6 conditions (ie, eyes open, eyes closed, visual sway, platform sway, eyes closed platform sway, platform and visual sway), including interpretation and report;
- 96369 Subcutaneous infusion for therapy or prophylaxis (specify substance or drug); initial, up to 1 hour, including pump set-up and establishment of subcutaneous infusion site(s).
Thank you for your continued participation and cooperation in our ongoing efforts to render quality health care to our members. We look forward to helping you provide the highest quality of care for our members.