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

Current through 2024-29, July 17, 2024
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