ICD-10 F10.27 is officially defined as "Alcohol dependence with alcohol-induced persisting dementia." code F10.27 is referenced in 3 tracked payer policy changes from Humana and Aetna. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code F10.27 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Humana Louisiana Medicaid has implemented a new antipsychotic utilization program requiring prior authorization for antipsychotic medications prescribed to patients with documented dementia diagnoses. The program includes strict age-based criteria and specific compendia-supported indications for approval.
Aetna considers the multiple sleep latency test (MSLT) and maintenance of wakefulness test (MWT) medically necessary to evaluate symptoms of narcolepsy to confirm the diagnosis, and for suspected idiopathic hypersomnia to help differentiate it from narcolepsy. A repeat MSLT or MWT is medically necessary only if the initial test was invalid or uninterpretable, was affected by extraneous circumstances or lacked study conditions, or the patient is suspected to have narcolepsy and an earlier test did not provide polygraphic confirmation. Home MSLT and single nap studies are experimental, investigational or unproven, as are these tests for other indications, including attention-deficit/hyperactivity disorder, chronic fatigue syndrome, insomnia, obstructive sleep apnea syndrome, restless leg syndrome, psychiatric hypersomnolence, and neurologic disorders other than narcolepsy such as dementia and Parkinson's disease.
Magnetic resonance spectroscopy (MRS) is considered medically necessary for specific indications in this policy, including assessing prognosis in hypoxic ischemic encephalopathy, distinguishing low grade from high grade gliomas, and distinguishing recurrent brain tumor from radiation-induced tumor necrosis. MRS is considered experimental, investigational, or unproven for all other indications listed, including breast cancer, prostate cancer, epilepsy, dementia and movement disorders, and traumatic brain injury. CPT 76390 is covered for the listed indications, and CPT codes 0609T, 0610T, 0611T and 0612T are not covered for the indications listed. The policy was last reviewed 03/26/2026.
Watch F10.27
Get one email when a payer policy names F10.27, a payer adds or drops it from a prior auth list, or Medicare changes its NCCI pairs, unit limit, payment or coverage articles.
Get alerts for changes like this
Save a search and get email alerts when a new policy change matches your filters: daily or weekly, your choice, on every plan.