F45.42 — Pain disorder with related psychological factors
F45.42 is a billable, specific ICD-10-CM code for pain disorder with related psychological factors. It is valid for submission on a claim.
Code also
Both codes may be needed to describe the encounter fully. Sequencing depends on the reason for the visit.
- associated acute or chronic pain (G89.-)
Excludes1 inherited from the categories above F45.42
These are not written on F45.42, but they bind it: a note on a category applies to every code beneath it. Billing F45.42 with anything listed here is a denial.
Excludes2 inherited from the categories above F45.42
Also inherited, and the opposite of Excludes1: these conditions are not part of F45.42, but a patient can have both, so you may code both.
Written on F45 — Somatoform disorders
- dissociative and conversion disorders (F44.-)
- factitious disorders (F68.1-, F68.A)
- hair-plucking (F63.3)
- lalling (F80.0)
- lisping (F80.0)
- malingering [conscious simulation] (Z76.5)
- nail-biting (F98.8)
- psychological or behavioral factors associated with disorders or diseases classified elsewhere (F54)
- sexual dysfunction, not due to a substance or known physiological condition (F52.-)
- thumb-sucking (F98.8)
- tic disorders (in childhood and adolescence) (F95.-)
- Tourette's syndrome (F95.2)
- trichotillomania (F63.3)
Risk adjustment
F45.42 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.
Medicare coverage
F45.42 is named in 15 Medicare coverage policies — 14 listing it as supporting medical necessity, and 1 listing it as NOT covered. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A52434Health and Behavior Assessment/Intervention – Medical Policy Articlenot covered
- A54799Billing and Coding: Urine Drug Testing
- A56619Billing and Coding: Nerve Conduction Studies and Electromyography
- A56645Billing and Coding: Controlled Substance Monitoring and Drugs of Abuse Testing
How F45.42 is indexed
Coders do not find codes by browsing the tabular list — they look them up in the alphabetic index, under the word the physician wrote. These are the index entries that lead here, so you can see which chart wordings map to F45.42.
- Disorder›pain›with related psychological factors
Code history
F45.42 has not changed since FY2024 — no addition, revision or deletion across the three most recent ICD-10-CM releases.
Related codes at this level
Codes that share F45.4. If F45.42 is not quite right, the correct code is usually one of these.
Questions about F45.42
- Is F45.42 a billable ICD-10-CM code?
- Yes. F45.42 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does F45.42 sit in the tabular list?
- Mental, Behavioral and Neurodevelopmental disorders (F01-F99), in the block Anxiety, dissociative, stress-related, somatoform and other nonpsychotic mental disorders (F40-F48).
- What cannot be coded together with F45.42?
- F45.42 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above F45.42 (F45.4) and apply to it just the same.