F51.12
F51.12: Insufficient sleep syndrome
Billable / specific codeICD-10-CM
F51.12 is a billable, specific ICD-10-CM code for insufficient sleep syndrome. It is valid for submission on a claim.
Check F51.12 with the rest of the claim: free scrubberExcludes1: never code together
These conditions cannot occur together. Billing both on the same encounter is a denial.
- sleep deprivation (Z72.820)
Excludes2 inherited from the categories above F51.12
Not part of this code, but both may be coded when both are present.
Written on F51.1: Hypersomnia not due to a substance or known physiological condition
- alcohol related hypersomnia (F10.182, F10.282, F10.982)
- drug-related hypersomnia (F11.182, F11.282, F11.982, F13.182, F13.282, F13.982, F14.182, F14.282, F14.982, F15.182, F15.282, F15.982, F19.182, F19.282, F19.982)
- hypersomnia NOS (G47.10)
- hypersomnia due to known physiological condition (G47.10)
- idiopathic hypersomnia (G47.11, G47.12)
- narcolepsy (G47.4-)
Risk adjustment
No CMS-HCC V28 category: this code does not change a RAF score.
Medicare coverage
F51.12 is named in 12 Medicare coverage policies: 10 listing it as supporting medical necessity, and 2 listing it as NOT covered. Which one applies depends on your Medicare contractor.
- A52434Health and Behavior Assessment/Intervention – Medical Policy Articlenot covered
- A56865Billing and Coding: Psychiatric Inpatient Hospitalizationnot covered
- A56923Billing and Coding: Outpatient Sleep Studies
- A56937Billing and Coding: Psychiatry and Psychology Services
Alphabetic index entries that lead here
- Insufficiency, insufficient›sleep syndrome
- Syndrome›insufficient sleep
Code history
Unchanged in every release from FY2024 to FY2027.