F78.A1: SYNGAP1-related intellectual disability
F78.A1, SYNGAP1-related intellectual disability, is listed as a covered diagnosis in 3 Medicare billing and coding articles that apply to 9 HCPCS Level II codes, including G0410 (Group psychotherapy other than of a multiple-family group…), G0129 (Occupational therapy services requiring the skills of a…), G0176 (Activity therapy, such as music, dance, art or play…). The articles come from 3 Medicare contractors. A listed diagnosis supports medical necessity only; coverage still depends on the LCD's criteria and on documentation in the medical record.
HCPCS Level II codes with F78.A1 as a covered diagnosis
| Code | Description | Medicare coverage | DMEPOS fee 2026 (state range) | Articles listing it |
|---|---|---|---|---|
| G0410 | Group psychotherapy other than of a multiple-family group, in a partial hospitalization or intensive outpatient setting, approximately 45 to 50 minutes | Carrier judgment | — | 1 |
| G0129 | Occupational therapy services requiring the skills of a qualified occupational therapist, furnished as a component of a partial hospitalization or intensive outpatient treatment program, per session (45 minutes or more) | Carrier judgment | — | 1 |
| G0176 | Activity therapy, such as music, dance, art or play therapies not for recreation, related to the care and treatment of patient's disabling mental health problems, per session (45 minutes or more) | Special coverage instructions apply | — | 1 |
| G0177 | Training and educational services related to the care and treatment of patient's disabling mental health problems per session (45 minutes or more) | Special coverage instructions apply | — | 1 |
| G0411 | Interactive group psychotherapy, in a partial hospitalization or intensive outpatient setting, approximately 45 to 50 minutes | Carrier judgment | — | 1 |
| G0451 | Development testing, with interpretation and report, per standardized instrument form | Carrier judgment | — | 2 |
| G0017 | Psychotherapy for crisis furnished in an applicable site of service (any place of service at which the non-facility rate for psychotherapy for crisis services applies, other than the office setting); first 60 minutes | Carrier judgment | — | 1 |
| G0018 | Psychotherapy for crisis furnished in an applicable site of service (any place of service at which the non-facility rate for psychotherapy for crisis services applies, other than the office setting); each additional 30 minutes (list separately in addition to code for primary service) | Carrier judgment | — | 1 |
| G0560 | Safety planning interventions, each 20 minutes personally performed by the billing practitioner, including assisting the patient in the identification of the following personalized elements of a safety plan: recognizing warning signs of an impending suicidal or substance use-related crisis; employing internal coping strategies; utilizing social contacts and social settings as a means of distraction from suicidal thoughts or risky substance use; utilizing family members, significant others, caregivers, and/or friends to help resolve the crisis; contacting mental health or substance use disorder professionals or agencies; and making the environment safe | Carrier judgment | — | 1 |
Medicare policy articles listing F78.A1
- A57053: Billing and Coding: Psychiatric Partial Hospitalization Programs (CGS Administrators, LLC (MAC - Part A, MAC - Part B); 5 Level II codes). LCD with the same title: L33626, L34196
- A57130: Billing and Coding: Psychiatric Codes (Novitas Solutions, Inc. (MAC - Part A, MAC - Part B); 4 Level II codes). LCD with the same title: L35101
- A57780: Billing and Coding: Psychological and Neuropsychological Tests (First Coast Service Options, Inc. (MAC - Part A, MAC - Part B); 1 Level II codes). LCD with the same title: L34520
A diagnosis listed as covered in a billing and coding article supports medical necessity for the article's codes; it does not guarantee payment. Coverage depends on the LCD's criteria, the contractor's jurisdiction and documentation in the medical record.
Other F78 diagnoses (Other intellectual disabilities)
- F78.A9 — Other genetic related intellectual disability
Frequently asked questions
Does Medicare cover F78.A1 (SYNGAP1-related intellectual disability)?
Medicare covers items and services, not diagnoses. 3 Medicare billing and coding articles list F78.A1 as a covered diagnosis for 9 HCPCS Level II codes: the diagnosis can support medical necessity for those codes, but payment still depends on the LCD's coverage criteria and the medical record.
Which HCPCS codes can be billed with ICD-10 F78.A1?
The Level II codes from the policies most specific to this diagnosis are G0410 (Group psychotherapy other than of a multiple-family group…, 1 article); G0129 (Occupational therapy services requiring the skills of a…, 1 article); G0176 (Activity therapy, such as music, dance, art or play…, 1 article); G0177 (Training and educational services related to the care and…, 1 article); G0411 (Interactive group psychotherapy, in a partial…, 1 article). Code choice depends on the item supplied; check each code's descriptor.
Which Medicare policy articles list F78.A1?
A57053 (Billing and Coding: Psychiatric Partial Hospitalization Programs); A57130 (Billing and Coding: Psychiatric Codes); A57780 (Billing and Coding: Psychological and Neuropsychological Tests).
What is ICD-10-CM code F78.A1?
F78.A1 is the ICD-10-CM code for SYNGAP1-related intellectual disability, in category F78 (Other intellectual disabilities), chapter 5: Mental, behavioral and neurodevelopmental disorders.
Next steps
- Run a reimbursement report for a device billed under G0410
- Watch G0410 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for G0410
Sources: CMS Medicare Coverage Database billing and coding articles (covered ICD-10 code lists and HCPCS links); ICD-10-CM FY2026; CMS HCPCS Level II release October 2026; CMS DMEPOS fee schedule 2026 (non-rural state fees). Not billing or legal advice.
Chapter 5: Mental, behavioral and neurodevelopmental disorders · All diagnoses · HCPCS lookup