Dementia Treatment Exclusion

Because there can be no restoration of function lost or impaired by dementia, HMSA's private business plans exclude coverage for treatments with a diagnosis dementia.

Coverage Under Federal Plan 87

HMSA will recognize dementia as a covered condition under Federal Plan 87 and HMSA Plan for Postal Service Employees. Services rendered with a diagnosis of dementia that are covered include:

• Diagnostic Testing (CPT 90791, 90792)
• Psychological Testing (CPT 96130-96131, 96136-96139, and 96146)

Because there can be no restoration of function, other treatments, including psychotherapy, are excluded from coverage.

Revision History