Information about EPSDT Diagnosis Code Changes

Attention VABA members who provide EPSDT Behavioral Therapy-Outpatient ABA services:

Recently, Magellan of Virginia released news that as of October 1, 2016, the new ICD-10-CM codes updated for the fiscal year 2017 are required for use for all service requests, discharges, and reimbursements.

At this time, it appears that there are no changes in codes for diagnoses that have been used for clients who may qualify for EPSDT Behavioral Therapy-Outpatient ABA. This is according to the CMS ICD-10 to ICD-10-CM Code Conversion Table and complete list of ICD-10-CM codes available here. For example, F84.0 Autistic Disorder in the original ICD-10 release remains as F84.0 in the ICD-10-CM table.

Additionally, as checked on 10/1/16 by a VABA member and EPSDT Outpatient Behavioral Therapy provider, the Magellan of Virginia provider website to request service authorizations is still set up with reference for the use of ICD-10 codes. It does not reference the need to use ICD-10-CM codes (again, none of the diagnostic codes appear to have been changed related to those who qualify for EPSDT Outpatient Behavioral Therapy Services).

If you have experienced difficulty specifically using ICD-10 codes to request EPSDT Behavioral Therapy-Outpatient ABA services going forth, please reference the ICD-10-CM code list first. Then, reach out to us at VABA to let us know! (

Happy October 2016!

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