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COVERAGE DETERMINATION GUIDELINE

Outpatient Treatment of Oppositional Defiant Disorder (ODD)


Guideline Number: BHCDG672011 Approval Date: April, 2011 Revised Date: Table of Contents: Instructions for Use Plan Document Language Indications for Coverage Coverage Limitations and Exclusions Definitions References Coding 1 2 2 12 13 14 14 Product: 2001 Generic UnitedHealthcare COC/SPD 2007 Generic UnitedHealthcare COC/SPD 2009 Generic UnitedHealthcare COC/SPD May also be applicable to other health plans and products Related Coverage Determination Guidelines: School-Based Services Related Medical Policies: Level of Care Guidelines American Academy of Child and Adolescent Psychiatry, Practice Parameter for the Assessment and Treatment of Children and Adolescents with Oppositional Defiant Disorder, 2007 National Institute for Health and Clinical Excellence, Parent-Training Education Programmes in the Management of Children with Conduct Disorders, 2007

INSTRUCTIONS FOR USE This Coverage Determination Guideline provides assistance in interpreting behavioral health benefit plans that are managed by United Behavioral Health. This Coverage Determination Guideline is also applicable to behavioral health benefit plans managed by Pacificare Behavioral Health, OptumHealth Behavioral Solutions, or U.S. Behavioral Health Plan, California. When deciding coverage, the enrollee specific document must be referenced. The terms of an enrollees document (e.g., Certificates of Coverage (COCs), Schedules of Benefits (SOBs), or Summary Plan Descriptions (SPDs)) may differ greatly from the standard benefit plans upon which this guideline is based. In the event that the requested service or procedure is limited or excluded from the benefit, is defined differently, or there is otherwise a conflict between this document and the COC/SPD, the enrollee's specific benefit document supersedes these guidelines. All reviewers must first identify enrollee eligibility, any federal or state regulatory requirements that supersede the COC/SPD and the plan benefit coverage prior to use of this guideline. Other coverage determination guidelines and clinical guideline may apply.
Outpatient Treatment of Oppositional Defiant Disorder (ODD) Coverage Determination Guideline Confidential and Proprietary, United Behavioral Health 2011 Page 1 of 15

United Behavioral Health reserves the right, in its sole discretion, to modify its coverage determination guidelines and clinical guidelines as necessary. While this Coverage Determination Guideline does reflect United Behavioral Healths understanding of current best practices in care, it does not constitute medical advice.

PLAN DOCUMENT LANGUAGE Before using this guideline, please check enrollees specific plan document and any federal or state mandates, if applicable. INDICATIONS FOR COVERAGE
Key Points According to the DSM, the onset of Oppositional Defiant Disorder (ODD) typically occurs by age 8 and includes a pattern of negativistic, hostile, and defiant behavior lasting at least 6 months, during which there is a presence of four or more of the following: o o o o o o o o Frequent loss of temper Frequent arguments with adults Often defies or refuses to comply with adults requests or rules Often deliberately annoys people Often blames others for his or her mistakes or misbehavior Often touchy or easily annoyed by others Often angry and resentful Often spiteful or vindictive Is more frequent than observed in individuals of comparable age and developmental level; Causes significant impairment in social, academic, or occupational functioning; Does not occur during the course of a Psychotic or Mood Disorder; and Does not meet the criteria for Conduct Disorder or Antisocial Personality Disorder.

Establishing a definitive diagnosis requires that the related disturbance: o o o o

Consider differential diagnosis to rule out disorders that mask or mimic ODD in addition to the identification of common co-occurring conditions that may complicate treatment such as ADHD, Substance Use Disorders, Mood Disorders, Anxiety Disorders, Adjustment Disorders and learning and developmental disabilities. Specifically consider whether the patient is exhibiting normal behavior according to age and stage of development. United Behavioral Health maintains that the treatment of ODD should be consistent with nationally recognized scientific evidence as available, and prevailing medical standards and clinical guidelines. Members with ODD should be treated in a level of care that is least restrictive and most likely to prove safe and effective. Choice of treatment should be driven by symptom severity, current level of functioning and the intensity of services necessary to address the active symptoms of ODD. Comprehensive treatment for ODD is typically treated in an outpatient setting. Symptom severity, current level of functioning and the intensity of services required to address the active symptoms of ODD should all be considered when choosing outpatient treatment.
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Outpatient Treatment of Oppositional Defiant Disorder (ODD) Coverage Determination Guideline Confidential and Proprietary, United Behavioral Health 2011

Factors which may rule out treatment in an outpatient setting include: o o o The patient is at imminent risk of harm to self or others and would be more safely treated in a more intensive level of care. The severity of symptoms or severity in functional impairment cannot be safely managed in an outpatient setting. A co-occurring behavioral health or medical condition complicates treatment to the extent that services in a more intensive level of care are indicated.

The goals of outpatient treatment for ODD are to improve the presenting signs and symptoms and to monitor and manage response to treatment. Best practices include the following: o Assessment and Evaluation Identify the precipitants for treatment, including the consequences of reported behaviors. Evaluate current symptoms to include mental status and functional impairment. Gather treatment information to include previous treatment, medication history and baseline level of functioning. Evaluate family history to include parent/child relationships, parental strategies, cultural considerations, and history of abuse or neglect. Gather information from multiple informants using multiple methods to include: Observational reports and clinical interviews with parents, daycare providers, teachers, family members, school professionals and selfreport. Rating scales for the diagnosis of ODD and for measuring behavioral progress over time.

Establish a therapeutic alliance with both the parents and the child/adolescent, being careful not to alienate the child or the parents. Evaluate the risk factors and safety of the patient including current suicide/homicide risk, patterns of aggression, violence, bullying or access to weapons. Determine each setting where ODD symptoms are exhibited. Complete differential diagnosis to rule out Conduct Disorder, Mood Disorders, Anxiety Disorders, Adjustment Disorders, ADHD, Substance Use Disorders, and Medical Conditions and also consider co-occurring conditions that may warrant concurrent treatment. This should also include an evaluation of current behaviors and whether they are developmentally appropriate as compared to expected behaviors for the childs stage of development. Consider reviewing the patients pediatric medical history to rule out medical conditions and to determine any prenatal/postnatal risk factors. Identify strengths and motivating factors. Evaluate the ability of the members family/social supports to participate in the members treatment and observe parent/child interactions when possible. The treatment plan must include objectives, actions and timeframes to address
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Treatment Planning

Outpatient Treatment of Oppositional Defiant Disorder (ODD) Coverage Determination Guideline Confidential and Proprietary, United Behavioral Health 2011

all of the following: o The precipitants for treatment and the plan to improve the patients functioning. A plan to achieve symptom reduction and rapid stabilization. A plan to manage co-occurring behavioral health and medical conditions. A plan to improve the patients ability to manage their condition. A plan to include the school system, family and support network as part of the active treatment plan as indicated and according to benefit coverage. A plan for reassessing the patients symptoms and functioning regularly. A plan for treatment discontinuation, including a plan to engage the family and support system.

Psychosocial Interventions Psychosocial interventions should be chosen in consideration of the childs age and developmental level. Treatments that are behaviorally based and coordinated with multiple systems that might include the family, school and community linkages are indicated for the treatment of ODD. Children with more severe forms of Oppositional Defiant Disorder, and those who have co-occurring behavioral health conditions which warrant treatment may require more than one psychosocial intervention. Consider Parent Management Training (PMT) in conjunction with other behaviorally-based individual, family and/or group therapies. Early identification programs delivered in schools, community clinics and in the homes of families are recommended. These programs target social skills, parenting, conflict resolution and anger management and have evidence to support improvement of ODD and may augment or prevent the need for further intervention. Coverage for such programs may not be supported by the benefit plan. Pharmacotherapy is generally not indicated to treat ODD and there are no medications that specifically treat ODD however, medications may be helpful as an adjunct to psychotherapy to treat comorbid conditions. The decision to taper or discontinue treatment should be a joint decision with the member and members family and should be derived from the members response to treatment, availability of family/social supports, a clear recovery and/or aftercare plan and consideration of the following: Treatment goals have been successfully completed, and remaining recovery goals can be self-managed or managed with peer support. An appropriate termination plan has been developed which includes referral to appropriate and necessary peer support and other community resources, as well as instructions for resuming services should the need arise in the future. The member refuses further treatment or repeatedly does not adhere with recommended treatment despite the deployment of motivational enhancement interventions, peer support and other community support services. The members presenting symptoms have been resolved or sufficiently
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Pharmacotherapy

Treatment Discontinuation and Maintenance

Outpatient Treatment of Oppositional Defiant Disorder (ODD)

reduced to the point that treatment is no longer necessary. The members level of functioning has sufficiently improved, there is no evidence of significant risk to self or others, and treatment is no longer necessary. Psychotropic medication and monitoring for possible relapse is no longer required, or medications are stabilized well enough and the primary care provider has agreed to take over prescribing requirements. The members parents/guardians have successfully developed and demonstrated parental strategies to safely manage the members symptoms and behaviors. Treatment is otherwise no longer necessary. The member should confirm that he/she understands and agrees with the plan including the risks of discontinuing treatment.

According to the DSM, the onset of Oppositional Defiant Disorder (ODD) typically occurs by age 8 and includes a pattern of negativistic, hostile, and defiant behavior lasting at least 6 months, during which there is a presence of four or more of the following: o Frequent loss of temper o Frequent arguments with adults o Often defies or refuses to comply with adults requests or rules o Often deliberately annoys people o Often blames others for his or her mistakes or misbehavior o Often touchy or easily annoyed by others o Often angry and resentful o Often spiteful or vindictive Establishing a definitive diagnosis requires that the related disturbance: o Is more frequent than observed in individuals of comparable age and developmental level; o Causes significant impairment in social, academic, or occupational functioning; o Does not occur during the course of a Psychotic or Mood Disorder; and o Does not meet the criteria for Conduct Disorder or Antisocial Personality Disorder. Consider differential diagnosis to rule out disorders that mask or mimic ODD in addition to the identification of common co-occurring conditions that may complicate treatment such as ADHD, Substance Use Disorders, Mood Disorders, Anxiety Disorders, Adjustment Disorders and learning disabilities. Specifically
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consider whether the patient is exhibiting normal behavior according to age and stage of development. Outpatient care consists of visits provided in an ambulatory setting for the purpose of assessing and treating a mental health condition. The goal of outpatient treatment is to improve the presenting signs and symptoms, monitor and manage response to treatment, and assist the patient and the family/support network with developing and maintaining treatment gains. United Behavioral Health maintains that Inpatient Treatment should be consistent with its Level of Care Guidelines and the Best Practice Guidelines adopted by United Behavioral Health. As such United Behavioral Health also maintains that optimal clinical outcomes result when evidence-based treatment is provided in the least restrictive level of available care that is structured and intensive enough to safely and adequately treat a members presenting problem and support the members recovery. The requested service or procedure must be reviewed against the language in the enrollee's benefit document. When the requested Outpatient Treatment service or procedure is limited or excluded from the enrollees benefit document, or is otherwise defined differently, it is the terms of the enrollee's benefit document that prevails. Benefits include the following services provided in an Outpatient Setting: Diagnostic evaluations and assessment Treatment planning Referral services Medication management Individual, family, therapeutic group and provider-based case management services Crisis intervention Comprehensive treatment for ODD is typically treated in an outpatient setting. Symptom severity, current level of functioning and the intensity of services required to address the active symptoms of ODD should all be considered when choosing outpatient treatment. Factors which may rule out treatment in an outpatient setting include: o The patient is at imminent risk of harm to self or others and would be more safely treated in a more intensive level of care. o The severity of symptoms or severity in functional impairment cannot be safely managed in an outpatient setting.

Indications for Coverage:

Outpatient Treatment of Oppositional Defiant Disorder (ODD) Coverage Determination Guideline Confidential and Proprietary, United Behavioral Health 2011

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o A co-occurring behavioral health or medical condition complicates treatment to the extent that services in a more intensive level of care are indicated. The goals of outpatient treatment for ODD are to improve the presenting signs and symptoms and monitor and manage response to treatment.

Best Practices for the Treatment of Oppositional Defiant Disorder Assessment and Evaluation Identify the precipitants for admission, including the consequences of reported behaviors. Evaluate current symptoms to include mental status and functional impairments. Gather treatment information to include previous treatment, medication history and baseline level of functioning. Evaluate family history to include parent/child relationships, parental strategies, cultural considerations, and history of abuse or neglect. o Family instability, economic stress, parental mental illness, harshly punitive behaviors, inconsistent parent practices, multiple moves, and divorce, may also contribute to the development of and exacerbate ODD symptoms. Gather information from multiple informants using multiple methods to include: o Observational reports and clinical interviews with parents, daycare providers, teachers, family members, school professionals and selfreport. o Rating scales for the diagnosis of ODD and for measuring behavioral progress over time. These may include the Conners Rating ScaleRevised (CPRS and CTRS), Achenbach Behavior Checklist: Child Behavior Checklist (CBCL, OASR), State Trait Anger Aggression Inventory (STAXI), and the Conners Wells Adolescent Self Report (CASS) Establish a therapeutic alliance with both the parents and the child/adolescent, careful not to alienate the child or the parents. Evaluate the risk factors and safety of the patient including current suicide/homicide risk, patterns of aggression, violence, bullying or access to weapons. Determine each setting where ODD symptoms are exhibited. o Children with ODD behavior in school should undergo necessary screening and/or testing in school to evaluate for possible learning disabilities. Coverage for testing is determined by the benefit plan.
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Complete differential diagnosis to rule out Conduct Disorder, Mood Disorders, Anxiety Disorders, Adjustment Disorders, ADHD, Substance Use Disorders, and Medical Conditions and also consider co-occurring conditions that may warrant concurrent treatment. This should also include an evaluation of current behaviors and whether they are developmentally appropriate as compared to expected behaviors for the childs stage of development. o Diagnosis may be complicated further by relatively high rates of comorbid or overlapping of symptoms of disorders such as ADHD and Conduct Disorder as ODD is highly comorbid with other medical and behavioral health conditions. o Comorbid conditions require treatment along with treatment of the ODD behaviors. If these comorbid conditions respond to treatment, then oppositional behavior may lessen or even disappear.

Consider reviewing the patients pediatric medical history to rule out medical conditions that might better explain the symptoms or the worsening of symptoms due to medical causes, and to determine any prenatal/postnatal risk factors. o This may include an evaluation of any prenatal risk factors to include, exposure to toxins, alcohol and poor nutrition.

Identify strengths and motivating factors. Evaluate the ability of the members family/social supports to participate in the members treatment and observe parent/child interactions when possible. The provider and the patient should document clear, reasonable and objective treatment and recovery goals that stem from the patients diagnosis, focus which address the patients symptoms, and take into account the patients preferences. When the member is a child or adolescent, treatment planning should be done with the members parent/guardian. Parents/guardians of child and adolescent members should participate in the members treatment unless clinically contraindicated. The treatment plan must include multimodal objectives, actions and timeframes to address all of the following: o The precipitants for admission and the plan to improve the patients functioning. o A plan to achieve symptom reduction and rapid stabilization. o A plan to manage co-occurring behavioral health and medical conditions. o A plan to improve the patients ability to manage their condition.

Treatment Planning

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o A plan to include the school system, family and support network as part of the active treatment plan when supported by the benefit plan. o A plan for reassessing the patients symptoms and functioning regularly. o A plan for treatment discontinuation. Contact the patients family and/or social support network, with the patients documented consent to regularly participate in the patients treatment and discharge planning when such participation is essential and clinically appropriate. Parents/guardians of child and adolescent patients should be contacted and should participate in the patients treatment unless clinically contraindicated. Optimally, the patients family and/or social support group should participate in treatment when the patient is a child or adolescent. Contact the patients outside providers and primary care practitioner, with the patients documented consent, if the patient was in treatment prior to admission to obtain information about the patients presenting condition and its treatment. The provider and the patient should collaborate to update the treatment plan in response to changes in the patients condition. o The treatment plan should be updated in response to changes in the members condition, or provide compelling evidence that continued treatment in the current level of care is required to prevent acute deterioration or exacerbation of the members current condition. o Linkages with community support services such as Family Bridger, Family Navigator or other peer services or support groups, which may be supported by the benefit plan should be considered Psychosocial Interventions Psychosocial interventions should be chosen in consideration of the childs age and developmental level. Treatments that are behaviorally based and coordinated with the family, school and any other significant others are indicated for the treatment of ODD. Children with more severe forms of Oppositional Defiant Disorder, and those who have co-occurring behavioral health conditions which warrant treatment may require more than one psychosocial intervention. Consider Parent Management Training (PMT) in conjunction with other behaviorally-based individual, family and/or group therapies. o Parent Management Training or other forms of family approaches should aim to reduce reinforcement of disruptive behavior, increase reinforcement of compliant behavior, apply consequences for disruptive behavior and make parental response predictable and immediate.
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PMT consists of procedures in which parents are trained to change their own behaviors and thereby alter their child's problem behavior in the home. Parental involvement in PMT is essential.

o Early identification programs delivered in schools, community clinics and in the homes of families are recommended. These programs target social skills, parenting, conflict resolution and anger management and have evidence to support improvement of ODD and may augment or prevent the need for further intervention. Coverage for such programs may not be supported by the benefit plan. School-based interventions may include preventive programs that focus on the development of socio-emotional skills, selfcontrol and problem solving.

o Individual approaches should be behaviorally based and geared toward the development of problem-solving skills. Behavioral interventions can aim to control aggression, modify behavior, and enhance communication and self-awareness. o Structured group therapy may be most helpful for adolescents focusing on communication, problem-solving and behavior management. Pharmacotherapy Pharmacotherapy is generally not indicated to treat ODD but may be helpful as an adjunct to psychotherapy to treat symptoms and/or comorbid conditions. If comorbid conditions are present, medications specifically targeting those conditions should be chosen however, atypical antipsychotics are often prescribed in treating acute aggression in a time limited manner. If medication use is chosen, the child in addition to the parents should agree and it should be clearly assessed whether adherence and monitoring are issues of concern.

Treatment Discontinuation The decision to taper or discontinue treatment should be a joint decision with the member and members family and should be derived from the members response to treatment, availability of family/social supports, a clear recovery and/or aftercare plan and consideration of the following: o Treatment goals have been successfully completed, and remaining recovery goals can be self-managed or managed with peer support. An appropriate termination plan has been developed which includes referral to appropriate and necessary peer support and other community resources, as well as instructions for resuming services should the need arise in the future.
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o The member refuses further treatment or repeatedly does not adhere with recommended treatment despite the deployment of motivational enhancement interventions, peer support and other community support services. o The members presenting symptoms have been resolved or sufficiently reduced to the point that treatment is no longer necessary. o The members level of functioning has sufficiently improved, there is no evidence of significant risk to self or others, and treatment is no longer necessary. o Psychotropic medication and monitoring for possible relapse is no longer required, or medications are stabilized well enough and the primary care provider has agreed to take over prescribing requirements. o The members parents/guardians have successfully developed and demonstrated parental strategies to safely manage the members symptoms and behaviors. o Treatment is otherwise no longer necessary. The member should confirm that he/she understands and agrees with the plan including the risks of discontinuation of treatment. Peer Review: United Behavioral Health will offer a peer review to the provider when services do not appear to conform with this guideline. The purpose of a peer review is to allow the provider the opportunity to share additional or new information about the case to assist the Peer Reviewer in making a determination including, when necessary, to clarify a diagnosis. Second Opinion Evaluation: United Behavioral Health facilitates obtaining a second opinion evaluation when requested by an enrollee, provider, or when United Behavioral Health otherwise determines that a second opinion is necessary to make a determination, clarify a diagnosis or improve treatment planning and care for the enrollee. Referral Assistance: United Behavioral Health provides assistance with accessing care when the provider and/or enrollee determine that there is not an appropriate match with the enrollees clinical needs and goals, or if additional providers should be involved in delivering treatment. Covered Health Service(s) UnitedHealthcare 2001 Those health services provided for the purpose of preventing, diagnosing or treating a sickness, injury, mental illness, substance abuse, or their symptoms. A Covered Health Service is a health care service or supply described in Section 1: What's Covered--Benefits as a Covered Health Service, which is not excluded under Section 2: What's Not Covered--Exclusions. Covered Health Service(s) UnitedHealthcare 2007 and 2009
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In Some Situations United Behavioral Health May Offer:

Those health services, including services, supplies, or Pharmaceutical Products, which we determine to be all of the following: Provided for the purpose of preventing, diagnosing or treating a Sickness, Injury, mental illness, substance abuse, or their symptoms. Consistent with nationally recognized scientific evidence as available, and prevailing medical standards and clinical guidelines as described below. Not provided for the convenience of the Covered Person, Physician, facility or any other person. Described in this Certificate of Coverage under Section 1: Covered Health Services and in the Schedule of Benefits. Not otherwise excluded in this Certificate of Coverage under Section 2: Exclusions and Limitations.

In applying the above definition, "scientific evidence" and "prevailing medical standards" shall have the following meanings: "Scientific evidence" means the results of controlled clinical trials or other studies published in peer-reviewed, medical literature generally recognized by the relevant medical specialty community. "Prevailing medical standards and clinical guidelines" means nationally recognized professional standards of care including, but not limited to, national consensus statements, nationally recognized clinical guidelines, and national specialty society guidelines.

United Behavioral Health maintains clinical protocols for the treatment of Adjustment Disorders that describe the scientific evidence, prevailing medical standards and clinical guidelines supporting our determinations regarding specific services. These clinical protocols (as revised from time to time), are available to Covered Persons upon request, and to Physicians and other behavioral health care professionals on ubhonline. COVERAGE LIMITATIONS AND EXCLUSIONS Inconsistent or Inappropriate Services or Supplies UnitedHealthcare 2001, 2007, 2009 Services or supplies for the diagnosis or treatment of Mental Illness that, in the reasonable judgment of United Behavioral Health, are any of the following: Not consistent with generally accepted standards of medical practice for the treatment of such conditions. Not consistent with services backed by credible research soundly demonstrating that the services or supplies will have a measurable and beneficial health outcome, and are therefore considered experimental.

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Not consistent with United Behavioral Healths level of care guidelines or best practice guidelines as modified from time to time. Not clinically appropriate for the patients Mental Illness or condition based on generally accepted standards of medical practice and benchmarks.

Additional Information: The lack of a specific exclusion of a service does not imply that the service is covered. The following are examples of inconsistent or inappropriate services for the treatment of Oppositional Defiant Disorder (not an all inclusive list): Services that deviate from the indications for coverage summarized in the previous section such as: o A mis-match between the symptoms of Oppositional Defiant Disorder, and the type and/or duration of treatment. o A treatment plan that has not been modified when there has been partial or no response to an adequate trial of treatment. Not coordinating care when more than one practitioner is delivering treatment. Not addressing co-occurring behavioral health medical conditions including substance use disorders in the treatment plan. Services continue even though treatment goals have been completed. Services continue despite repeated failures to adhere with recommended treatment despite the deployment of motivational enhancement interventions, peer support, school-based and other community resources. Coverage for school-based services such as screening and testing for learning disabilities and/or school delivered programs not supported by the benefit plan.

Please refer to the enrollees benefit document for ASO plans with benefit language other than the generic benefit document language. {INCLUDE FOR ASO ONLY: For ASO plans with SPD language other than 2001 and 2007 Generic COC language, Please refer to the enrollees plan specific SPD for coverage.

DEFINITIONS Diagnostic and Statistical Manual of the American Psychiatric Association (DSM) A manual produced by the American Psychiatric Association which provides the diagnostic criteria for mental health and substance use disorders,
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and other problems that may be the focus of clinical attention. Unless otherwise noted, the current edition of the DSM applies. Mental Illness Those mental health or psychiatric diagnostic categories that are listed in the current Diagnostic and Statistical Manual of the American Psychiatric Association, unless those services are specifically excluded under the Policy. Oppositional Defiant Disorder (ODD) According to the DSM, the essential feature of Oppositional Defiant Disorder is pattern of negativistic, hostile, and defiant behavior lasting at least 6 months, during which there is a presence of four or more of the following: Frequent loss of temper, frequent arguments with adults, often defies or refuses to comply with adults requests or rules, often deliberately annoys people, often blames others for his or her mistakes or misbehavior, often touchy or easily annoyed by others, often angry and resentful, often spiteful or vindictive. Outpatient Treatment Outpatient treatment in indicated when the presenting symptoms support a diagnosis of Adjustment Disorders. Outpatient treatment care consists of visits provided in an ambulatory setting for the purpose of assessing and treating a mental health condition. REFERENCES 1. Generic UnitedHealthcare Certificate of Coverage, 2001 2. Generic UnitedHealthcare Certificate of Coverage, 2007 3. Generic UnitedHealthcare Certificate of Coverage, 2009 4. American Academy of Child and Adolescent Psychiatry, Practice Parameter for the Assessment and Treatment of Children and Adolescents with Oppositional Defiant Disorder, 2007. 5. American Academy of Child and Adolescent Psychiatry, Oppositional Defiance Disorders Resources, 2011. 6. National Institute for Health and Clinical Excellence, Parent-Training Education Programmes in the Management of Children with Conduct Disorders, 2007. CODING
The Current Procedural Terminology (CPT) codes and HCPCS codes listed in this guideline are for reference purposes only. Listing of a service code in this guideline does not imply that the service described by this code is a covered or non-covered health service. Coverage is determined by the benefit document. Limited to specific CPT and HCPCS codes? 90801-90815, 90845-90899 Limited to specific diagnosis codes? 313.81
Outpatient Treatment of Oppositional Defiant Disorder (ODD) Coverage Determination Guideline Confidential and Proprietary, United Behavioral Health 2011

YES NO Outpatient

YES NO Oppositional Defiant Disorder


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Limited to place of service (POS)?

YES NO Outpatient

Limited to specific provider type?

YES

x x

NO

Limited to specific revenue codes?

YES

NO

HISTORY
Revision Date 04/20/11 Name L. Hernandez Revision Notes

The enrollee's specific benefit documents supersede these guidelines and are used to make coverage determinations. These Coverage Determination Guidelines are believed to be current as of the date noted.

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