F45.42
F45.42: Pain disorder with related psychological factors
Billable / specific codeICD-10-CM
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.
Check F45.42 with the rest of the claim: free scrubberCode 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
A category’s note binds every code beneath it.
Excludes2 inherited from the categories above F45.42
Not part of this code, but both may be coded when both are present.
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
No CMS-HCC V28 category: this code does not change a RAF score.
Medicare coverage
F45.42 is named in 14 Medicare coverage policies: 13 listing it as supporting medical necessity, and 1 listing it as NOT covered. Which one applies depends on your Medicare contractor.
- 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
Alphabetic index entries that lead here
- Disorder›pain›with related psychological factors
Code history
Unchanged in every release from FY2024 to FY2027.