Oppositional Defiant Disorder, Intensive Outpatient ... - Ubhonline.com

OPTUM 

By United Behavioral Health 

COVERAGE 

DETERMINATION 

GUIDELINE 

Intensive Outpatient Treatment of 

Oppositional Defiant Disorder (ODD) 

Guideline Number: BHCDG672012 

Approval Date: April, 2011 

Revised Date: November, 2012 

Table of Contents: 

Instructions for Use 1 

Plan Document Language 2 

Indications for Coverage 2 

Coverage Limitations and Exclusions 10 

Definitions 11 

References 11 

Coding 12 

Product: 

2001 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 

Association for Ambulatory Behavioral 

Healthcare, 2008 

INSTRUCTIONS FOR USE 

This Coverage Determination Guideline provides assistance in interpreting behavioral health 

benefit plans that are managed by Optum. This Coverage Determination Guideline is also 

applicable to behavioral health benefit plans managed by Optum or U.S. Behavioral Health Plan, 

California. 

When deciding coverage, the enrollee specific document must be referenced. The terms of an 

enrollee’s 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 of a conflict, the enrollee's specific benefit document 

supersedes these guidelines. 

All reviewers must first identify enrollee eligibility, any federal or state regulatory requirements 

and the plan benefit coverage prior to use of this guideline. Other coverage determination 

guidelines and clinical guideline may apply. 

PLAN DOCUMENT LANGUAGE 

Before using this guideline, please check enrollee’s specific plan document and 

any federal or state mandates, if applicable. 

Intensive Outpatient Treatment of Oppositional Defiant Disorder (ODD) Page 1 of 14 

Coverage Determination Guideline 

Confidential and Proprietary, © Optum 2012 

Optum is a brand used by United Behavioral Health and its affiliates

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 (Diagnostic and 

Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV-TR), 2000): 

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 

Establishing a definitive diagnosis requires that the related disturbance (DSM-IV-TR): 

o 

o 

o 

o 

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. 

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 should be completed. Specifically consider 

whether the patient is exhibiting normal behavior according to age and stage of development 

(American Academy of Child and Adolescent Psychiatry (AACAP), 2007). 

Optum maintains that the treatment of ODD should be consistent with nationally recognized 

scientific evidence as available, and prevailing medical standards and clinical guidelines. 

Comprehensive treatment for ODD is typically treated in an outpatient setting. Members with 

ODD should be treated in a level of care that is least restrictive and most likely to prove safe 

and effective (Optum Level of Care Guidelines (LOCGs), 2012). Choice of intensive 

outpatient treatment is indicated for members with at least one of the following: 

o 

o 

o 

Moderate symptoms of ODD that cannot be managed in a less intensive level of 

care and/or a higher level of care may be required if IOP is not provided 

(Association for Ambulatory Mental Healthcare (AABH), 2008); 

Moderate impairment in the member’s psychological, social, occupational, 

educational, or other area of functioning has impacted the member’s ability to 

perform regular daily activities as compared to baseline (AABH, 2008); 

The member has completed treatment at a higher level of care and continues to 

require the monitoring provided in an IOP setting (AABH, 2008). 





o 

o 

o 

The member’s co-occurring medical, psychiatric and substance use conditions 

can be safely managed in an intensive outpatient treatment setting (AABH, 

2008). 

The member is not at imminent risk of serious harm to self or others (AABH, 

2008). 

The member or his/her support system understands and can comply with the 

requirements of IOP (AABH, 2008). 

The goals of Intensive Outpatient treatment for ODD are to stabilize the presenting signs and 

symptoms to the extent that the intensity of IOP services is no longer required and the 

member can safely transition to outpatient care. 

Best practices include the following: 

o 

o 

o 

o 

o 

Assessment and Evaluation 

Treatment Planning 

Psychosocial Interventions 

Pharmacotherapy 

Treatment Discontinuation and Maintenance 

An intensive outpatient program (IOP) is a freestanding or hospital-based 

program that maintains hours of service for at least 3 hours per day, 2 or more 

days per week. It may be used as an initial point of entry into care, as a step up 

from routine outpatient services, or as a step down from acute inpatient, 

residential care or a partial hospital program (AABH, 2008). 

An IOP can be used to treat mental health conditions or can specialize in the 

treatment of co-occurring mental health and substance use disorders (LOCGs, 

2012) 

When supported by the benefit plan, coverage may be available for intensive 

outpatient programs that are provided with less intensity to members who are 

recovering from severe and persistent mental health conditions (LOCGs, 2012). 

The requested service or procedure must be reviewed against the language in 

the enrollee's benefit document. When the requested Intensive Outpatient 

Treatment service or procedure is limited or excluded from the enrollee’s 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 intensive outpatient 

setting: 

Diagnostic evaluations and assessment 

Treatment planning 

Referral services 

Medication management 





Individual, family, therapeutic group and provider-based case management 

services 

Crisis intervention 

Best Practices for the Treatment of Oppositional Defiant Disorder 

Evaluation and Diagnosis 

Engagement and collaboration with the member’s parents/guardians should 

be considered at the time treatment begins for increased accuracy of the 

assessment and improved treatment outcomes (American Academy of Child 

and Adolescent Psychiatry (AACAP), 2007). 

Identify the precipitants for the admission/initiation of IOP treatment, current 

symptoms and consequences of reported symptoms/behaviors (AACAP, 

2007). 

Complete a psychiatric evaluation to include mental status, family history, 

functional impairments and the administration of indicated rating scales 

(AACAP, 2007). 

The assessment should focus on gathering information directly from the child 

as well as from the parents/guardians separately regarding the core 

symptoms of ODD, age of onset, duration of symptoms and degree of 

functional impairment (AACAP, 2007). 

Gather treatment information to include previous treatment, medication 

history and baseline level of functioning (AACAP, 2007). 

Evaluate family history to include parent/child relationships, parental 

strategies, cultural considerations, and history of abuse or neglect (AACAP, 

2007). 

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 (AACAP, 2007). 

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 

(AACAP, 2007). 

o Rating scales for the diagnosis of ODD and for measuring behavioral 

progress over time. These may include the Conner’s Rating Scale- 

Revised (CPRS and CTRS), Achenbach Behavior Checklist: Child 

Behavior Checklist (CBCL, OASR), State Trait Anger Aggression 

Inventory (STAXI), and the Conner’s Wells Adolescent Self Report 

(CASS) (AACAP, 2007). 





Evaluate the risk factors and safety of the patient including current 

suicide/homicide risk, patterns of aggression, violence, bullying or access to 

weapons (AACAP, 2007). 

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 

(AACAP, 2007). 

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 child’s stage of development 

(AACAP, 2007). 

o Diagnosis may be complicated further by relatively high rates of 

comorbid or overlapping of symptoms of disorders such as ADHD and 

Conduct Disorder and comorbidities 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 patient’s 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 (AACAP, 2007). 

o This may include an evaluation of any prenatal risk factors to include, 

exposure to toxins, alcohol and poor nutrition (AACAP, 2007). 

Evaluate the ability of the member’s family/social supports to participate in the 

member’s treatment and observe parent/child interactions when possible 

(AACAP, 2007). 

Treatment Planning 

 

The treatment plan must include objectives, actions and timeframes to 

address all of the following: 

o The precipitants for treatment and the plan to improve the patient’s 

functioning. 

o A plan to improve behaviors that precipitated admission. 

o A plan to manage co-occurring behavioral health and medical 

conditions. 





o A plan to improve the patient’s ability to manage their condition. 

o A plan for reassessing the patient’s symptoms and functioning 

regularly. 

o Coordinating treatment with agencies and programs such as the 

school, court system or protective services with which the member has 

been involved; and 

o Preparing the member for transition from IOP treatment and the 

introduction of post-discharge care in the community. 

Within 48 hours of admission the provider and, whenever possible, the 

member should document clear, reasonable and objective treatment goals 

and timeframes that stem from the member’s diagnosis, and are supported by 

specific treatment strategies which address the member’s symptoms and the 

precipitant for admission (LOCGs, 2012). 

o The treatment plan and appropriateness of level of care should be 

updated every 3-5 days as new information becomes available or if 

the member’s status changes (LOCGs, 2012). 

o The treatment plan should always address co-occurring behavioral 

and medical conditions including substance disorders (LOCGs, 

2012). 

The treatment plan must include objectives, actions and timeframes to 

address all of the following (LOCGs, 2012): 

o Identify impairments and interventions that will maximize the patient’s 

quality of life. 

o Determine how symptom reduction and rapid stabilization will be 

achieved. 

o Determine how co-occurring behavioral health and medical conditions, 

if any, will be managed. 

o Determine how the patient’s ability to manage their condition will be 

improved such as by providing health education, and linking the patient 

with peer services and other community resources. 

o Determine how risk issues related to the patient’s presenting condition, 

co-occurring behavioral health or medical conditions will be managed 

including how the patient’s motivation will be maintained/enhanced, 

and collaborating with the patient to develop/revise the advance 

directive or relapse prevention plan. 

o Determine whether the patient has an advance directive, a recovery 

plan, and a plan for managing relapse. 





Contact the patient’s family and/or social support network, with the patient’s 

documented consent to regularly participate in the patient’s treatment and 

discharge planning when such participation is essential and clinically 

appropriate (LOCGs, 2012). 

Parents/guardians of child and adolescent patients should be contacted and 

should participate in the patient’s treatment unless clinically contraindicated. 

Optimally, the patient’s family and/or social support group should participate 

in treatment when the patient is a child or adolescent (LOCGs, 2012). 

The provider and the patient collaborate to update the treatment plan in 

response to changes in the patient’s condition (LOCGs, 2012). 

Psychosocial Interventions 

 

 

 

 

Psychosocial interventions should be chosen in consideration of the child’s 

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 (AACAP, 2007). 

Treatments often include a combination of individual psychotherapy, family 

psychotherapy, pharmacotherapy and environmental intervention (e.g., 

school-based interventions) (AACAP, 2007). 

Evidenced-based treatments for ODD include individual problem-solving skills 

training that is behaviorally-based and family interventions in the form of 

Parent Management Training (PMT) (AACAP, 2007). 

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 (AACAP, 2007). 

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 (AACAP, 2007). 

• 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 (AACAP, 

2007). 

• School-based interventions may include preventive programs 

that focus on the development of socio-emotional skills, selfcontrol 

and problem solving (AACAP, 2007). 

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 (AACAP, 2007). 

o Structured group therapy may be most helpful for adolescents focusing 

on communication, problem-solving and behavior management 

(AACAP, 2007). 

o Alternative family approaches include Functional Family Therapy 

(FFT) and Multisystemic Therapy shown to be most effective for 

members with ODD and Substance Use Disorders (AACAP, 2007). 

o Inoculation approaches (e.g., boot camps, shock incarceration) have 

been considered ineffective and even harmful especially when used in 

isolation from evidence-based approaches (AACAP, 2007). 

o Interventions should be delivered as long as clinically indicated, 

usually for several months with periodic “booster” sessions, reinforcing 

learned skills for both the member and family/guardians (AACAP, 

2007). 

Pharmacotherapy 

 

 

 

 

Pharmacotherapy is generally not indicated to treat ODD as a sole 

intervention but may be helpful as an adjunct to psychotherapy to treat 

aggressive symptoms and/or comorbid conditions (AACAP, 2007). 

Medication intervention is best introduced after a strong alliance with the 

member and family has been established and only after psychosocial 

interventions have been implemented (AACAP, 2007). 

If comorbid conditions are present, medications specifically targeting those 

conditions should be chosen however, atypical antipsychotics, mood 

stabilizers (e.g., divalproex and lithium), and stimulants are often 

prescribed in treating acute aggression in a time limited manner (AACAP, 

2007). 

Medications should only be started after a symptom baseline can be 

established as to not attribute positive outcomes to medications rather 

than a stabilizing environment (AACAP, 2007). 

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 (AACAP, 2007). 





Nonresponsiveness to a specific agent should lead to a trial of another 

class of medication rather than the addition of other medications (AACAP, 

2007). 

Pharmacological treatments are typically short-term and/or time-limited 

however, prolonged treatment may be required due to usually severe and 

persistent ODD or ODD that co-occurs with other behavioral health 

conditions (AACAP, 2007). 

Discharge Planning and Referral Management 

Members in IOP may be discharged by either stepping up to a more intensive 

level of care when his/her condition has not improved or has worsened; or 

stepping down to a less intensive level of outpatient care when the member’s 

clinical condition improves or he/she no longer requires structured, intensive, 

multimodal treatment. (CMS Manual System, 2004). 

 

The discharge plan must include the anticipated discharge date and the 

following (LOCGs, 2012): 

o The next level of care, its location, and the name(s) of the 

provider(s) who will deliver treatment; 

o The rationale for the referral; 

o The date and time of the first appointment for treatment as well 

as the first follow-up psychiatric assessment within 7 days of 

discharge; 

o The recommended modalities of care and the frequency of each 

modality; 

o The names, dosages and frequencies of each medication, and a 

schedule for appropriate lab tests if pharmacotherapy is a 

modality of post-discharge care 

o Linkages with peer services and other community resources. 

o The plan to communicate all pertinent clinical information to the 

provider(s) responsible for post-discharge care, as well as to the 

member’s primary care provider as appropriate. 

o The plan to coordinate discharge with agencies and programs 

the member has been involved, when appropriate and with the 

member’s documented consent. 

o A prescription for a supply of medication sufficient to bridge the 

time between discharge and the scheduled follow-up psychiatric 

assessment. 

o Confirmation that the member or authorized representative 

understands the discharge plan. 





o Confirmation that the member or authorized representative was 

provided with written instruction for what to do in the event that 

a crisis arises prior to the first post-discharge appointment. 

In Some Situations Optum May Offer: 

Peer Review: Optum 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: Optum facilitates obtaining a second opinion 

evaluation when requested by an enrollee, provider, or when Optum 

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: Optum provides assistance with accessing care when 

the provider and/or enrollee determine that there is not an appropriate match 

with the enrollee’s clinical needs and goals, or if additional providers should 

be involved in delivering treatment. 

IOP admissions require pre-service notification. Notification of a scheduled 

admission must occur at least five (5) business days before admission. 

Notification of an unscheduled admission (including Emergency admissions) 

should occur as soon as is reasonably possible. In the event that the Mental 

Health/Substance Use Disorder Designee is not notified of an IOP admission, 

benefits may be reduced. Check the member’s specific benefit plan document for 

the applicable penalty and provision for a grace period before applying a penalty 

for failure to notify the Mental Health/Substance Use Disorder Designee as 

required. 

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, 2009 & 2011 

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. 

Optum maintains clinical protocols for the treatment of ODD 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 & 2011 

Services or supplies for the diagnosis or treatment of Mental Illness that, in the 

reasonable judgment of the Mental Health/Substance Use Disorders Designee, 

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. 

Not consistent with the Mental Health/Substance Use Disorder Designee’s 

level of care guidelines or best practice guidelines as modified from time 

to time. 





Not clinically appropriate for the patient’s 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. 

Admission to IOP treatment without appropriate management of acute 

symptoms. 

Admission to IOP treatment solely as a substitute for an available lower 

level of care, an intensified schedule of ambulatory care, or a broadened 

treatment plan. 

Admission to IOP treatment that does not provide an adequate program 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 enrollee’s 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 enrollee’s 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, 

and other problems that may be the focus of clinical attention. Unless otherwise 

noted, the current edition of the DSM applies. 

Intensive Outpatient Program An intensive outpatient program (IOP) is a 

freestanding or hospital-based program that maintains hours of service for at 

least 3 hours per day, 2 or more days per week. It may be used as an initial point 

of entry into care, as a step up from routine outpatient services, or as a step 

down from acute inpatient, residential care or a partial hospital program. 

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. 

REFERENCES 

1. Generic UnitedHealthcare Certificate of Coverage, 2001 




5. American Academy of Child and Adolescent Psychiatry, Practice Parameter 

for the Assessment and Treatment of Children and Adolescents with 

Oppositional Defiant Disorder, 2007. 

6. American Academy of Child and Adolescent Psychiatry, Oppositional Defiant 

Disorders Resources, 2011. 

7. Association for Ambulatory Mental Healthcare, Standards and Guidelines for 

Partial Hospital and Intensive Outpatient Treatment Programs, 2008. 

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? 

x YES □ NO 

H0015 

S9480 

Intensive outpatient (treatment program that 

operates at least 3 hours/day and at least 3 

days/week and is based on an individualized 

treatment plan), including assessment, 

counseling; crisis intervention, and activity 

therapy. 

Intensive outpatient psychiatric services, per 

diem 

Limited to specific diagnosis codes? 

x YES □ NO 

313.81 Oppositional Defiant Disorder 

Limited to place of service (POS)? 

x YES □ NO 

Intensive Outpatient Program 

Limited to specific provider type? 

□ YES x NO 

Limited to specific revenue codes? 

□ YES x NO 

HISTORY 

Revision Date Name Revision Notes 

12/2/12 L. Urban Version 2-Final 

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.

Oppositional Defiant Disorder, Intensive Outpatient ... - Ubhonline.com

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