Clinical Policy: Attention Deficit Hyperactivity Disorder

Assessment and Treatment
Reference Number: CP.BH.124
Date of Last Revision: 03/24
[Coding Implications](Coding Implications)
[Revision Log](Revision Log)

See [Important Reminder](Important Reminder) at the end of this policy for important regulatory and legal information.

Description

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.

III. It is the policy of Centene Advanced Behavioral Health and health plans affiliated with Centene Corporation that interventions that are strictly educational in nature (e.g., classroom environmental manipulation, academic skills training) are not medically necessary as they are not considered medical interventions.

Background

ADHD (Attention Deficit Hyperactivity Disorder) is one of the most commonly diagnosed neurodevelopmental disorders in children and adolescents and is increasingly being diagnosed in adults.⁵ The main characteristics of ADHD are symptoms of inattention, hyperactivity, and impulsivity that have continued for at least six months and are maladaptive and inconsistent with development level.¹ There is no single genetic or behavioral test to diagnose ADHD. Instead, a clinical diagnosis based on the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) criteria is applicable for both children and adults.² Due to the prevalence of children and adolescents with an ADHD diagnosis, treatment of ADHD is often managed in the primary care setting, and evidence supports that appropriate diagnosis can be accomplished in this setting.⁵ However, primary care prescribers should refer children to a specialist for complex ADHD symptoms.¹⁶ Some of the more common comorbid disorders include anxiety, autism spectrum disorder, depression, disruptive behavior disorders, substance use disorders and Tic disorders.³,¹⁶ Suggested first line treatment for adults with ADHD is medication rather than cognitive-behavioral therapy (CBT).¹⁸

American Academy of Pediatrics (AAP)

In 2011, the AAP published a clinical practice guideline to clarify the diagnosis, evaluation, and treatment parameters of ADHD with an update in 2019.⁴ This guideline expanded the age range of children to include preschool aged children (4 to 6 years of age) and adolescents (12 to 18 years of age), and suggests an expanded scope for behavioral interventions.⁴ The evaluation of comorbid conditions, including behavioral, emotional, developmental, and physical, that might coexist with ADHD must also be considered.⁴,⁵ Most children and adolescents diagnosed with ADHD also meet diagnostic criteria for other behavioral health conditions. In some situations, the presence of a comorbid diagnosis will alter the course of ADHD treatment. Additionally, when an adolescent receives a new diagnosis of ADHD, an assessment for substance use, anxiety, depression, and learning disorders should also be conducted, as these are common comorbid conditions that may alter the treatment approach of the adolescent population.⁵ Similar clinical recommendations have been made by various organizations for adults, including the Canadian ADHD Resource Alliance, the American Academy of the Child and Adolescent Psychiatry, the National Institutes of Health, and the British Association for Psychopharmacology.⁵ Pharmacotherapy can provide a way to manage ADHD symptoms and improve quality of life.

In 2020, The Society for Developmental and Behavioral Pediatrics (SDBP) published Clinical Practice Guideline for the Assessment and Treatment of Children and Adolescents with Complex Attention-Deficit/Hyperactivity Disorder and Process of Care Algorithms (POCA) that are meant to be used as companion documents to the published guidelines. The algorithms include suggested steps in the treatment of complex ADHD and key concepts include focus on functional impairment to improve long-term outcomes, psychosocial treatment as foundational in the treatment of complex ADHD, shared decision making, interprofessional care, using mental health diagnostic assessment and testing appropriately, identifying and treating impairments caused by coexisting conditions, and a lifelong perspective. These algorithms are based on expert consensus, and review of existing publications and practice guidelines and are meant to improve the care that children and adolescents with complex ADHD receive.

Stimulants and non-stimulants are common examples of medications prescribed to treat ADHD. A systemic review of sixteen randomized clinical trials and one meta-analysis that involved 2668 participants and evaluated pharmacological and psychosocial treatments of ADHD in adolescents 12 to 18 years of age was completed.⁷ The findings demonstrated that extended-release methylphenidate and amphetamine formulations, atomoxetine, and extended-release guanfacine led to clinically significant symptom reduction.⁷ Nonstimulants are not approved by the FDA for use in preschool-aged children. There is strong evidence for stimulant medications and significant evidence, but less strong, for atomoxetine, extended release guanfacine, and extended-release clonidine. Due to the lack of significant studies in school-aged children for nonstimulant medication and dextroamphetamine, methylphenidate is recommended as the first line of pharmacologic treatment for this population.⁵ Findings from clinical trials studying adults with noncomorbid ADHD suggest amphetamines as first-line treatment when compared to other medications or cognitive-behavioral therapy (CBT).¹⁸ Methylphenidate is noted as the first option of treatment for adults with moderate or severe ADHD; however, the evidence on the effects of immediate-release (IR) methylphenidate is limited and controversial in the treatment of the adult population.¹⁷

The AAP (American Academy of Pediatrics) has established recommendations regarding treatment modalities based on age. It is recommended that preschool children (4 to 6 years of age) are first prescribed evidence-based behavioral Parent Training in Behavior Management (PTBM) and/or classroom interventions. If these methods are not effective, Methylphenidate can be considered. For elementary and middle school children (6 to 12 years of age), a combination of FDA approved medications for ADHD and PTBM and classroom interventions should be prescribed. Educational interventions and supports, including an Individualized Education Program (IEP) are a vital part of treatment. Adolescents (12 to 18 years of age) should be treated with FDA approved medications in conjunction with evidence-based training or behavioral interventions. Educational interventions and supports are also an important aspect of treatment in this age group and can include an IEP or 504 plan. Additionally, planning for adulthood is an important component of the chronic care model for ADHD.⁵

The AAP also recognizes psychosocial treatments as effective for the treatment of ADHD. These treatments may include behavioral therapy and training interventions. Behavioral therapy can help adults (parents and school staff) to learn how to respond effectively and prevent certain behaviors, such as interrupting, aggression, non-compliance with requests, and non-completion of tasks. Skill development is targeted in training interventions and include repeated practice and performance feedback. The effectiveness of certain training interventions, such as social skills training, is not supported by research.⁵

While the pathogenesis of ADHD is unknown, the clinical impairments in neurobehavioral and neurodevelopmental functioning pathways elicit deficiencies in vigilance, perceptual-motor speed, working memory, verbal learning, and response inhibition.² Consequently, ADHD affects the cognitive, academic, emotional, and social wellbeing of individuals and can persist throughout life. ADHD is a chronic condition and children and adolescents with ADHD should be managed in the same way those with special health care needs would be managed. Principles of the chronic care model and the medical home should be followed.⁵

Coding Implications

This clinical policy references Current Procedural Terminology (CPT®). CPT® is a registered trademark of the American Medical Association. All CPT codes and descriptions are copyrighted 2023, American Medical Association. All rights reserved. CPT codes and CPT descriptions are from the current manuals and those included herein are not intended to be all-inclusive and are included for informational purposes only. Codes referenced in this clinical policy are for informational purposes only. Inclusion or exclusion of any codes does not guarantee coverage. Providers should reference the most up-to-date sources of professional coding guidance prior to the submission of claims for reimbursement of covered services.

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**CLINICAL POLICY**  
Attention Deficit Hyperactivity Disorder  

| CPT® Codes | Description |
|------------|-------------|
| 95726 | spike and seizure detection, interpretation, and summary report, complete study; greater than 84 hours of EEG recording, without video |
| 95925 | Electroencephalogram (EEG), continuous recording, physician or other qualified health care professional review of recorded events, analysis of spike and seizure detection, interpretation, and summary report, complete study; greater than 84 hours of EEG recording, with video (VEEG) |
| 95926 | Short-latency somatosensory evoked potential study, stimulation of any/all peripheral nerves or skin sites, recording from the central nervous system; in upper limbs |
| 95927 | Short latency somatosensory evoked potential study, stimulation of any/all peripheral nerves or skin sites, recording from the central nervous system; in lower limbs |
| 95928 | Short latency somatosensory evoked potential study, stimulation of any/all peripheral nerves or skin sites, recording from the central nervous system; in the trunk or head |
| 95929 | Central motor evoked potential study (transcranial motor stimulation); upper limbs |
| 95930 | Central motor evoked potential study (transcranial motor stimulation); lower limbs |
| 95933 | Visual evoked potential (VEP), checkerboard or flash testing, central nervous system except glaucoma, with interpretation and report |
| 95937 | Orbicularis oculi (blink) reflex, by electrodiagnostic testing |
| 95938 | Neuromuscular junction testing (repetitive stimulation paired stimuli), each nerve, any 1 method |
| 95939 | Short latency somatosensory evoked potential study, stimulation of any/all peripheral nerves or skin sites, recording from the central nervous system; in upper and lower limbs |
| 95954 | Central motor evoked potential study (transcranial motor stimulation); in upper and lower limbs |
| 95957 | Pharmacological or physical activation requiring physician or other qualified health care professional attendance during EEG recording of activation phase (eg, thioptental activation test) |
| 96020 | Digital analysis of electroencephalogram (EEG) (eg, for epileptic spike analysis) |
| 96116 | Neurofunctional testing selection and administration during noninvasive imaging functional brain mapping, with test administered entirely by a physician or other qualified health care professional (ie, psychologist), with review of test results and report |
| 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 |

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**CLINICAL POLICY**  
Attention Deficit Hyperactivity Disorder  

| CPT® Codes | Description |
|------------|-------------|
| 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 |
| 96365 | Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour |
| 96366 | Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each additional hour (List separately in addition to code for primary procedure) |
| 96367 | Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); additional sequential infusion of a new drug/substance, up to 1 hour (List separately in addition to code for primary procedure) |
| 96902 | Microscopic examination of hairs plucked or clipped by the examiner (excluding hair collected by the patient) to determine telogen and anagen counts, or structural hair shaft abnormality |
| 97010 | Application of a modality to 1 or more areas; hot or cold packs |
| 97012 | Application of a modality to 1 or more areas; traction, mechanical |
| 97014 | Application of a modality to 1 or more areas; electrical stimulation (unattended) |
| 97016 | Application of a modality to 1 or more areas; vasopneumatic devices |
| 97018 | Application of a modality to 1 or more areas; paraffin bath |
| 97022 | Application of a modality to 1 or more areas; whirlpool |
| 97024 | Application of a modality to 1 or more areas; diathermy (eg, microwave) |
| 97026 | Application of a modality to 1 or more areas; infrared |
| 97028 | Application of a modality to 1 or more areas; ultraviolet |
| 97032 | Application of a modality to 1 or more areas; electrical stimulation (manual), each 15 minutes |
| 97033 | Application of a modality to 1 or more areas; iontophoresis, each 15 minutes |
| 97034 | Application of a modality to 1 or more areas; contrast baths, each 15 minutes |
| 97035 | Application of a modality to 1 or more areas; ultrasound, each 15 minutes |
| 97036 | Application of a modality to 1 or more areas; Hubbard tank, each 15 minutes |
| 97129 | Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing, and sequencing tasks), direct (one-on-one) patient contact; initial 15 minutes |
| 97130 | Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing, and sequencing tasks), direct (one-on-one) patient contact; each additional 15 minutes (List separately in addition to code for primary procedure) |

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**CLINICAL POLICY**  
Attention Deficit Hyperactivity Disorder  

| CPT® Codes | Description |
|------------|-------------|
| 97151 | Behavior identification assessment, administered by a physician or other qualified health care professional, each 15 minutes of the physician's or other qualified health care professional's time face-to-face with patient and/or guardian(s)/caregiver(s) administering assessments and discussing findings and recommendations, and non-face-to-face analyzing past data, scoring/interpreting the assessment, and preparing the report/treatment plan |
| 97152 | Behavior identification-supporting assessment, administered by one technician under the direction of a physician or other qualified health care professional, face-to-face with the patient, each 15 minutes |
| 97153 | Adaptive behavior treatment by protocol, administered by technician under the direction of a physician or other qualified health care professional, face-to-face with one patient, each 15 minutes |
| 97154 | Group adaptive behavior treatment by protocol, administered by technician under the direction of a physician or other qualified health care professional, face-to-face with two or more patients, each 15 minutes |
| 97155 | Adaptive behavior treatment with protocol modification, administered by physician or other qualified health care professional, which may include simultaneous direction of technician, face-to-face with one patient, each 15 minutes |
| 97156 | Family adaptive behavior treatment guidance, administered by physician or other qualified health care professional (with or without the patient present), face-to-face with guardian(s)/caregiver(s), each 15 minutes |
| 97157 | Multiple-family group adaptive behavior treatment guidance, administered by physician or other qualified health care professional (without the patient present), face-to-face with multiple sets of guardians/caregivers, each 15 minutes |
| 97158 | Group adaptive behavior treatment with protocol modification, administered by physician or other qualified health care professional, face-to-face with multiple patients, each 15 minutes |
| 97530 | Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes |
| 97533 | Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands, direct (one-on-one) patient contact, each 15 minutes |
| 97810 | Acupuncture, one or more needles, w/o electric stimulation; initial 15 minutes of personal one-one contact with the patient |
| 97811 | Acupuncture, one or more needles, w/o electric stimulation; each additional 15 minutes of personal one-one contact with the patient, with re-insertion of needle(s) |
| 97813 | Acupuncture, one or more needles, with electric stimulation; initial 15 minutes of personal one-one contact with the patient |
| 97814 | Acupuncture, one or more needles, with electric stimulation; each additional 15 minutes of personal one-one contact with the patient, with re-insertion of the needle(s) (List separately in addition to code for primary procedure) |

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**CLINICAL POLICY**  
Attention Deficit Hyperactivity Disorder  

| CPT® Codes | Description |
|------------|-------------|
| 98940 | Chiropractic manipulative treatment (CMT); spinal, 1 to 2 regions |
| 98941 | Chiropractic manipulative treatment (CMT); spinal, 3 to 4 regions |
| 98942 | Chiropractic manipulative treatment (CMT); spinal, 5 regions |
| 98943 | Chiropractic manipulative treatment (CMT); extraspinal, 1 or more regions |

**HCPCS codes considered not medically necessary when billed with a sole diagnosis of ADHD**  

| HCPCS Codes | Description |
|-------------|-------------|
| G0176 | Activity therapy, such as music, dance, art or play therapies not for recreation, related to the care and treatment of patient's disabling mental health problems, per session (45 minutes or more) |
| P2031 | Hair analysis (excluding arsenic) |
| S8040 | Topographic brain mapping |

**ICD-10-CM Diagnosis Codes that Support Medical Necessity**  

| ICD-10-CM Code | Description |
|---------------|-------------|
| F90.0 through F90.9 | Attention-deficit hyperactivity disorders |

**Reviews, Revisions, and Approvals**  

| Reviews, Revisions, and Approvals | Revision Date | Approval Date |
|----------------------------------|---------------|---------------|
| Policy developed | 08/16 | 08/16 |
| References reviewed and updated | 07/17 | 08/17 |
| Assessment: Added “Evaluation of iron status (e.g. measurement of serum iron and ferritin levels)” as not medically necessary. References and Codes reviewed and updated. | 05/18 | 05/18 |
| Added AFF2 gene testing and measurement of peripheral brain-derived neurotrophic factor as investigational to II.A. Code updates-deleted CPT 96101, 96102, 96103, 96118, 96119, 96120, and 97532. Added CPT-96130, 96131, 96132, 96133, 96136, 96137, 96138, 96139, 96146, and 97127. References reviewed and updated. Specialist reviewed. | 04/19 | 05/19 |
| Revised description for CPT-96116 | 05/19 |  |
| Removed the following codes from the list of CPT codes considered not medically necessary when billed with a sole diagnosis of ADHD: 96136, 96137, 96138, 96139, 96146. | 12/19 |  |
| Clarified in the medical necessity statement in I. that the following services are medically necessary when requested. Removed the following codes from the list of CPT codes considered not medically necessary when billed with a sole diagnosis of ADHD: 96130, 96131. | 01/20 |  |

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**CLINICAL POLICY**  
Attention Deficit Hyperactivity Disorder  

| Reviews, Revisions, and Approvals | Revision Date | Approval Date |
|----------------------------------|---------------|---------------|
| Policy reviewed. References reviewed and updated. Updated Section I.A. to include “collection of collateral information” and “toxicology screen.” Updated Section I.B. to include “ongoing assessment and application of standardized scales to assess treatment benefit.” Updated Section II. “Investigational or unproven” assessments and treatments with the following: pharmacogenetic tools; Cannabidiol oil; cognitive training; external trigeminal nerve stimulation (eTNS); mindfulness; and supportive counseling, to reflect the 2019 version of American Academy of Pediatrics (AAP) Clinical Practice Guidelines. Edited Section II.A.19. to read “Neuro Biofeedback/EEG Biofeedback.” Updated AAP recommended treatment modalities. Added information regarding The Society for Developmental and Behavioral Pediatrics (SDBP) Clinical Practice Guidelines and Process of Care Algorithms for Assessment and Treatment of Children and Adolescents with Complex ADHD. Updated Background section to include most recent prevalent statistics and the necessity of treatment by Primary Care Providers. <br> CPT Code Updates: Removed 78607, 95827, 97127. Added 78803, 81171, 81172, 92547, 95705, 95706, 95707, 95708, 95709, 95710, 95711, 95713, 95714, 95715, 95716, 95717, 95718, 95719, 95720, 95721, 95722, 95723, 95724, 95725, 95726, 96121, 97129, 97130. HCPCS Code Updates: Added G0176. | 04/20 | 05/20 |
| Revised language in I.A.5.d. to specify ECG can be performed only if clinically indicated. Added applicable CPT codes 93000, 93005 and 93010 to not medically necessary table when billed with a sole diagnosis of ADHD. Added assessment of serum lipid profiles to II.A, as well as applicable codes 80061, 83718, 83719, 82721, 83722 and 84475 to not medically necessary table when billed with a sole diagnosis of ADHD. Removed CPT-92585, 92586 -codes deleted in 2021. Replaced with 92650, 92651, 92652 and 92653. Revised description of CPT- 95930. Replaced all instances of “member” with “member/enrollee.” | 04/21 | 05/21 |
| Annual review. “Experimental/investigational” verbiage replaced in policy statement with “there is insufficient evidence to support.” References reviewed, updated, and reformatted. Duplicate reference removed. Changed “review date” in the header to “Date of Last Revision” and “Date” in the revision log header to “Revision date”. Added “Findings from clinical trials studying adults with noncomorbid ADHD suggest amphetamines as first-line treatment when compared to other medications or cognitive-behavioral therapy (CBT). Methylphenidate is also the first option of treatment for adults with moderate or severe ADHD; however, the evidence on the effects of immediate-release (IR) methylphenidate is limited and controversial in the treatment of the adult population” and “Suggested first line treatment for adults with ADHD is medication rather than cognitive-behavioral therapy (CBT)” to the Background section with no impact to criteria. | 02/22 | 02/22 |

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**CLINICAL POLICY**  
Attention Deficit Hyperactivity Disorder  

| Reviews, Revisions, and Approvals | Revision Date | Approval Date |
|----------------------------------|---------------|---------------|
| Revised description of CPT-81229, 92065, 96366 and 97814. Approval by BH Clinical Policy Subcommittee. | 02/23 | 03/23 |
| Annual Review. Changed reference number for the policy from “CP.MP.124” to “CP.BH.124”. Added the following statement to section I and II: “It is the policy of Centene Advanced Behavioral Health and health plans affiliated with Centene Corporation”. In criteria point II. A. 1. replaced “Actometer” with “Actigraphy”. In criteria point I.A. 2. added “Acoustic reflex testing”. In criteria point I.A.12: removed Magnetic resonance imaging, brain functional MRI as it is already captured in I.A.16: under MRI. Removed I.A.14: “Neurofunctional testing selection and administration during noninvasive imaging functional brain mapping”. In criteria point I.A.16: added “brain mapping” to the brain imaging section. In Criteria point I.A.16 removed “Triiodothyronine T3 levels in the blood” and reworded as “Measures of thyroid hormones”. Removed IIA.18 “neuropsychological testing from the insufficient evidence list”, with corresponding codes also removed. In criteria point II. B.2., added “Application of modality (e.g. hot or cold packs, traction, mechanical, electrical stimulation (unattended), vasopneumatic devices, paraffin bath, whirlpool, diathermy (eg, microwave), infrared, ultraviolet, electrical stimulation (manual), iontophoresis, contrast baths, ultrasound, hubbard tank)”. Removed education interventions from criteria point II.B.19. and added policy statement III. “It is the policy of Centene Advanced Behavioral Health and health plans affiliated with Centene Corporation that interventions that are strictly educational in nature (e.g., classroom environmental manipulation, academic skills training training) are not medically necessary and are not considered medical interventions”. Added criteria point II.B.19. “EndeavorRx®”. Replaced instances of dashes (-) with the word “to” within the CPT description code list. Coding reviewed. Added the following codes and related indications as not medically necessary when billed with a sole diagnosis of ADHD: 70496, 70544, 70555, 78610, 84436, 84437, 84439, 84442, 84443, 84445, 84478, 84479, 84481, 92568, 92569, 92570, 95954, 96020, 96902, 97010, 97012, 97014, 97016, 97018, 97022, 97024, 97026, 97028, 97032, 97033, 97034, 97035, 97036. References reviewed and updated. Policy reviewed by internal specialist. Policy reviewed by an external specialist. | 03/23 | 03/24 |
| Annual review. Added examples to IIA.5. under “Computerized electroencephalogram”. Updated II.B.9 to “Cannabinoids and cannabinoid products”. Removed “Supportive counseling” and “Vayarin” from II.B. Replaced “Endeavor RX®” with “Video game-based interventions (e.g., EndeavorRX, AKL-T01) in II.B.39. Added CPT codes 70544, 70545, 70546, 95957 as well as CPT codes 97151 through 97158 for ABA services included under II.B.23 “Intensive behavioral | 03/24 | 03/24 |

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**CLINICAL POLICY**  
Attention Deficit Hyperactivity Disorder  

**References**  
1. Post RE, Kurlansik SL. Diagnosis and management of adult attention-deficit/hyperactivity disorder. *Am Fam Physician*. 2012;85(9):890 to 896.  
2. Bukstein O. Attention deficit hyperactivity disorder in adults: Epidemiology, pathogenesis, clinical features, course, assessment, and diagnosis. UpToDate. www.uptodate.com. Updated November 27, 2023. Accessed January 4, 2024.  
3. Krull KR. Attention deficit hyperactivity disorder in children and adolescents: Epidemiology and pathogenesis. UpToDate. www.uptodate.com. Updated March 9, 2023. Accessed January 4, 2024.  
4. Krull KR. Attention deficit hyperactivity disorder in children and adolescents: Overview of treatment and prognosis. UpToDate. www.uptodate.com. Updated September 19, 2023. Accessed January 4, 2024.  
5. Wolraich ML, Hagan JF Jr, Allan C, et al. Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents (published correction appears in Pediatrics. 2020 Mar;145(3)]:e20192528. doi:10.1542/peds.2019 to 2528  
6. Gibbins C, Weiss M. Clinical recommendations in current practice guidelines for diagnosis and treatment of ADHD in adults. *Curr Psychiatry Rep*. 2007;9(5):420 to 426. doi:10.1007/s11920-007-0055-1  
7. Chan E, Fogler JM, Hammerness PG. Treatment of Attention-Deficit/Hyperactivity Disorder in Adolescents: A Systematic Review. *JAMA*. 2016;315(18):1997 to 2008. doi:10.1001/jama.2016.5453  
8. Pliszka S; AACAP Work Group on Quality Issues. Practice parameter for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder. *J Am Acad Child Adolesc Psychiatry*. 2007;46(7):894 to 921. doi:10.1097/chi.0b013e318054e724  
9. Gloss D, Varma JK, Pringsheim T, Nuwer MR. Practice advisory: The utility of EEG theta/beta power ratio in ADHD diagnosis: Report of the guideline development, dissemination, and implementation subcommittee of the american academy of neurology. *Neurology*. 2016;87(22):2375 to 2379. doi:10.1212/WNL.0000000000003265  
10. Tseng PT, Cheng YS, Yen CF, et al. Peripheral iron levels in children with attention-deficit hyperactivity disorder: a systematic review and meta-analysis. *Sci Rep*. 2018;8(1):788. Published 2018 Jan 15. doi:10.1038/s41598-017-19096-x  
11. Wang Y, Huang L, Zhang L, Qu Y, Mu D. Iron Status in Attention-Deficit/Hyperactivity Disorder: A Systematic Review and Meta-Analysis. *PLoS One*. 2017;12(1):e0169145. Published 2017 Jan 3. doi:10.1371/journal.pone.0169145  
12. Krull KR. Attention deficit hyperactivity disorder in children and adolescents: Clinical features and diagnosis. UpToDate. www.uptodate.com. Updated March 9, 2023. Accessed January 4, 2024.  

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**CLINICAL POLICY**  
Attention Deficit Hyperactivity Disorder  

**References**  
13. Dalrymple RA, McKenna Maxwell L, Russell S, Duthie J. NICE guideline review: Attention deficit hyperactivity disorder: diagnosis and management (NG87). *Arch Dis Child Educ Pract Ed*. 2020;105(5):289 to 293. doi:10.1136/archdischild-2019-316928  
14. Barbaresi WJ, Campbell L, Diekroger EA, et al. Society for Developmental and Behavioral Pediatrics Clinical Practice Guideline for the Assessment and Treatment of Children and Adolescents with Complex Attention-Deficit/Hyperactivity Disorder. *J Dev Behav Pediatr*. 2020;41 Suppl 2S:S35 to S57. doi:10.1097/DBP.0000000000000770  
15. Berger S. Cardiac evaluation of patients receiving pharmacotherapy for attention deficit hyperactivity disorder. UpToDate. www.uptodate.com. Updated March 16, 2023. Accessed January 4, 2024.  
16. Not just ADHD? Helping children with multiple concerns. Centers for Disease Control and Prevention. Updated September 27, 2023. Accessed February 19, 2024.  
17. Cândido RCF, Menezes de Padua CA, Golder S, Junqueira DR. Immediate-release methylphenidate for attention deficit hyperactivity disorder (ADHD) in adults. *Cochrane Database Syst Rev*. 2021;1(1):CD013011. Published 2021 Jan 18. doi:10.1002/14651858.CD013011.pub2  
18. Brent D, Bukstein O, Solanto MV. Attention deficit hyperactivity disorder in adults: Treatment overview. UpToDate. www.uptodate.com. Updated August 10, 2023. Accessed January 4, 2024.  
19. Young S, Hollingdale J, Absoud M, et al. Guidance for identification and treatment of individuals with attention deficit/hyperactivity disorder and autism spectrum disorder based upon expert consensus. *BMC Med*. 2020;18(1):146. doi:10.1186/s12916-020-01585-y  
20. National Institute for Mental Health. Attention Deficit Hyperactivity Disorder. https://nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd. Updated September 2023. Accessed January 4, 2024.  

**Important Reminder**  
This clinical policy has been developed by appropriately experienced and licensed health care professionals based on a review and consideration of currently available generally accepted standards of medical practice; peer-reviewed medical literature; government agency/program approval status; evidence-based guidelines and positions of leading national health professional organizations; views of physicians practicing in relevant clinical areas affected by this clinical policy; and other available clinical information. The Health Plan makes no representations and accepts no liability with respect to the content of any external information used or relied upon in developing this clinical policy. This clinical policy is consistent with standards of medical practice current at the time that this clinical policy was approved. “Health Plan” means a health plan that has adopted this clinical policy and that is operated or administered, in whole or in part, by Centene Management Company, LLC, or any of such health plan’s affiliates, as applicable.  

The purpose of this clinical policy is to provide a guide to medical necessity, which is a component of the guidelines used to assist in making coverage decisions and administering benefits. It does not constitute a contract or guarantee regarding payment or results. Coverage decisions and the administration of benefits are subject to all terms, conditions, exclusions and limitations of the coverage documents (e.g., evidence of coverage, certificate of coverage, policy, contract of insurance, etc.), as well as to state and federal requirements and applicable Health Plan-level administrative policies and procedures.  

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**CLINICAL POLICY**  
Attention Deficit Hyperactivity Disorder  

This clinical policy is effective as of the date determined by the Health Plan. The date of posting may not be the effective date of this clinical policy. This clinical policy may be subject to applicable legal and regulatory requirements relating to provider notification. If there is a discrepancy between the effective date of this clinical policy and any applicable legal or regulatory requirement, the requirements of law and regulation shall govern. The Health Plan retains the right to change, amend or withdraw this clinical policy, and additional clinical policies may be developed and adopted as needed, at any time.  

This clinical policy does not constitute medical advice, medical treatment, or medical care. It is not intended to dictate to providers how to practice medicine. Providers are expected to exercise professional medical judgment in providing the most appropriate care and are solely responsible for the medical advice and treatment of members/enrollees. This clinical policy is not intended to recommend treatment for members/enrollees. Members/enrollees should consult with their treating physician in regard to diagnosis and treatment decisions.  

Providers referred to in this clinical policy are independent contractors who exercise independent judgment and over whom the Health Plan has no control or right of control. Providers are not agents or employees of the Health Plan.  

This clinical policy is the property of the Health Plan. Unauthorized copying, use, and distribution of this clinical policy or any information contained herein are strictly prohibited. Providers, members/enrollees and their representatives are bound to the terms and conditions expressed herein through the terms of their contracts. Where no such contract exists, providers, members/enrollees and their representatives agree to be bound by such terms and conditions by providing services to members/enrollees and/or submitting claims for payment for such services.  

**Note:** For Medicaid members/enrollees, when state Medicaid coverage provisions conflict with the coverage provisions in this clinical policy, state Medicaid coverage provisions take precedence. Please refer to the state Medicaid manual for any coverage provisions pertaining to this clinical policy.  

**Note:** For Medicare members/enrollees, to ensure consistency with the Medicare National Coverage Determinations (NCD) and Local Coverage Determinations (LCD), all applicable NCDs, LCDs, and Medicare Coverage Articles should be reviewed prior to applying the criteria set forth in this clinical policy. Refer to the CMS website at http://www.cms.gov for additional information.  

©2018 Centene Corporation. All rights reserved. All materials are exclusively owned by Centene Corporation and are protected by United States copyright law and international copyright law. No part of this publication may be reproduced, copied, modified, distributed, displayed, stored in a retrieval system, transmitted in any form or by any means, or otherwise published without the prior written permission of Centene Corporation. You may not alter or remove any trademark, copyright or other notice contained herein. Centene® and Centene Corporation® are registered trademarks exclusively owned by Centene Corporation.  

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