Code of Maine Rules
10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES
144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL
Chapter 101 - MAINECARE BENEFITS MANUAL (FORMERLY MAINE MEDICAL ASSISTANCE MANUAL)
Chapter II - Specific Policies By Service
Section 144-101-II-107 - Psychiatric Residential Treatment Facility Services
Appendix 144-101-II-107-A - Qualifying Diagnoses
|
Category |
Diagnosis |
ICD-10 |
|
Schizophrenia Spectrum |
Schizophrenia |
F20.9 |
|
Moderate and Severe Modifier |
Paranoid schizophrenia |
F20.0 |
|
Disorganized schizophrenia |
F20.1 |
|
|
Catatonic schizophrenia |
F20.2 |
|
|
Undifferentiated schizophrenia |
F20.3 |
|
|
Residual schizophrenia |
F20.5 |
|
|
Schizophreniform disorder |
F20.81 |
|
|
Schizoaffective disorder, bi-polar type |
F25.0 |
|
|
Schizoaffective disorder, depressive type |
F25.1 |
|
|
Other Schizoaffective disorders |
F25.8 |
|
|
Bipolar and Related Disorders |
Bipolar I disorder, current episode manic w/out psychotic features, moderate |
F31.12 |
|
Bipolar I disorder, current episode manic w/out psychotic features, severe |
F31.13 |
|
|
Bipolar I disorder, current episode manic, severe with psychotic features |
F31.2 |
|
|
Bipolar I disorder, current episode depressed, moderate |
F31.32 |
|
|
Bipolar I disorder, current episode depressed, severe, w/out psychotic features |
F31.4 |
|
|
Bipolar I disorder, current episode depressed, severe, with psychotic features |
F31.5 |
|
|
Bipolar I disorder, current episode mixed, moderate |
F31.62 |
|
|
Bipolar I disorder, current episode mixed, severe, w/out psychotic features |
F31.63 |
|
|
Bipolar I disorder, current episode mixed, severe, with psychotic features |
F31.64 |
|
|
Bipolar I disorder in partial remission, most recent episode manic |
F31.73 |
|
|
Bipolar I disorder, in partial remission, most recent episode depressed |
F31.75 |
|
|
Bipolar I disorder, in partial remission, most recent episode mixed |
F31.77 |
|
|
Bipolar II disorder |
F31.81 |
|
|
Other bipolar disorder |
F31.89 |
|
|
Cyclothymic Disorder |
F34.0 |
|
|
Depressive Disorders |
Major depressive disorder, single episode, moderate |
F32.1 |
|
Major depressive disorder, single episode, severe w/out psychotic features |
F32.2 |
|
|
Major depressive disorder, single episode, severe with psychotic features |
F32.3 |
|
|
Major depressive disorder, single episode, in partial remission |
F32.4 |
|
|
Major depressive disorder, recurrent, moderate |
F33.1 |
|
|
Major depressive disorder, recurrent, severe w/out psychotic symptoms |
F33.2 |
|
|
Major depressive disorder, recurrent, severe, with psychotic symptoms |
F33.3 |
|
|
Major depressive disorder, recurrent, in partial remission |
F33.41 |
|
|
Disruptive mood dysregulation disorder |
F34.8 |
|
|
Anxiety Disorders |
Panic Disorder |
F41.0 |
|
Generalized anxiety disorder |
F41.1 |
|
|
Personality Disorder |
Borderline Personality Disorder |
|
|
Trauma and Stressor Related Disorders |
Posttraumatic stress disorder |
F43.10 |
|
Posttraumatic stress disorder, acute |
F43.11 |
|
|
Posttraumatic stress disorder, chronic |
F43.12 |
|
|
Dissociative Disorder |
Dissociative identity disorder |
F44.81 |
|
Disruptive, Impulse-Control, and Conduct Disorders |
Oppositional defiant disorder |
F91.3 |
|
Intermittent Explosive Disorder |
F63.81 |
|
|
NeuroDevelopmental Disorders |
Attention Deficit Hyperactivity Disorders |
F90-F90.9 |
