Child Health Programs Eligibility Conditions 2011-2012 DIAGNOSES BY PROGRAM CMS BCW FIRST CARE NEWBORN SCREENING HEARING CATEGORIES, CODES, DIAGNOSES: 001-139: INFECTIOUS AND PARASITIC DISEASES 042 HIV X 052.9 Varicella, congenital X X 079.6 Respiratory syncytial virus (RSV) X 090.9 Syphilis, congenital-unspecified X 140-239: NEOPLASMS 190.5 Malignant neoplasm of retina (includes Retinoblastoma) X 216 Benign neoplasm of skin X X 237.70 Neurofibromatosis X 240-279: ENDOCRINE, NUTRITIONAL AND METABOLIC DISEASES, AND IMMUNITY DISORDERS 242.0 Toxic diffuse goiter (Hyperthyroidism) X 243 Congenital hypothyroidism X X X 244 Acquired hypothyroidism X 250 Diabetes mellitus X X 252 Disorders of the parathyroid gland X 253 Disorders of the pituitary gland X 253.3 Pituitary dwarfism X 253.5 Diabetes insipidus X 255 Disorders of adrenal glands X 255.0 Cushing's syndrome X 255.2 Adrenogenital disorders (includes Congenital adrenal hyperplasia) X X 259.0 Delay in sexual development and puberty X 259.1 Precocious sexual development and puberty X 259.8 Other specified endocrine disorders X 270.0 Disturbances of amino-acid transport (includes Cystinosis, Hartnup disease) X 270.1 Phenylketonuria (PKU), Hyperphenylalaninemia X X X Other disturbances of aromatic amino-acid metabolism (includes Albinism, Tyrosinosis, 270.2 Tyrosinuria/Tyrosemia-types I, II, III) X X X X (Albinism) Disturbances of branched-chain amino-acid metabolism (includes Maple syrup urine disease, Methylmalonic acidemia, Propionic acidemia, Isovaleric acidemia, Isobutyryl- 270.3 CoA dehydrogenase) X X X 270.4 Disturbances of sulphur-bearing amino-acid metabolism (includes Homocystinuria) X X X Disorders of urea cycle metabolism (includes Argininosuccinic aciduria, Citrullinemia, Carbamoyl phosphate synthetase I deficiency, Hyperargininemia, Ornithine 270.6 transcarbamylase deficiency) X X X Other disturbances of straight-chain amino-acid metabolism (includes Glutaric aciduria, 270.7 Type I) X X X Other specified disorders of amino-acid metabolism (includes 2-Hydroxyglutaric aciduria, Lowe syndrome, Molybdenum cofactor deficiency, Pediatric neurotransmitter disease, 270.8 2-Methyl-3-hydroxybutaric aciduria, 2-Methylbutyryl-CoA dehydrogenase) X X X 270.9 Unspecified disorder of amino-acid metabolism (includes 3-Methylglutaconic aciduria) X X X Glycogenosis (includes Pompe disease-Type II, McArdle/myophosphorlase deficiency- 271.0 Type V) X X X (Type II) 271.1 Galactosemia (includes Galactokinase defiency, X X X 1 Child Health Programs Eligibility Conditions 2011-2012 DIAGNOSES BY PROGRAM CMS BCW FIRST CARE NEWBORN SCREENING HEARING CATEGORIES, CODES, DIAGNOSES: Other specified disorders of carbohydrate transport and metabolism (includes Carbohydrate deficiency glycoprotein syndrome-Type I, Fucosidosis, Pyruvate carboxylase 271.8 deficiency, Pyruvate dehydrogenase deficiency) X X Unspecified disorder of carbohydrate transport and metabolism (Includes Schindler's 271.9 Disease) X 272.2 Mixed hyperlipidemia (includes Xanthomatosis) X X Lipoprotein deficiencies (includes Abetalipoproteinemia/Bassen-Kornzweig syndrome, 272.5 Hypobetalipoproteinemia) X X Lipidoses (includeds Infantile Gaucher disease, Cerebrotendinous Xanthomatosis, 272.7 Niemann-Pick syndrome) X X 275.1 Disorders of copper metabolism (includes Wilson's disease) X X 275.3 Disorders of phosphorus metabolism (includes Vitamin D-resistant rickets) X Other specified disorders of mineral metabolism (includes Menkes kinky hair syndrome 275.8 xq12-q13) X X Acidosis (includes 3-Hydroxy-3-Methylglutaryl-CoA Lyase deficiency, 3-Methylcrotonyl- CoA Carboxylase deficiency, B-Ketothiolase deficiency, Multiple-CoA-Carboxylase 276.2 deficiency) X X 277 Other and unspecifieid disorders of metabolism (includes Fumerase deficiency) X 277.0 Cystic Fibrosis X X X 277.2 Other disorders of purine and pyrimidine metabolism (includes Lesch-Nyhan disease) X X Mucopolysacharidosis I (Hunter Syndrome), II (Hurler Syndrome), III (Sanfilippo 277.5 Syndrome) X X 277.6 Other deficiencies of circulating enzymes (includes Biotinidase deficiency) X X X 277.81 Primary carnitine deficiency X X 277.82 Carnitine deficiency due to inborn errors of metabolism X X 277.84 Other secondary carnitine deficiency X X Disorders of fatty acid oxidation (includes the following deficiencies listed below*: LCHAD, 277.85 CUD, CPT1/CPT2, MAD, LCAD/VLCAD, MCADD, SCAD, TFP) X X *3-Hydroxy Long Chain Acyl-CoA Dehydrogenase (LCHAD) Deficiency X X *Carnitine Uptake Defect (CUD) X *Carnitine palmitoyltranserase deficiencies (CPT1, CPT2) X X X *Glutaric Aciduria type II, Multiple Acyl-CoA Dehydrogenase (MAD) X X X *Long Chain/Very Long Chain Acyl-CoA-Dehydrogenase Deficiency (LCAD, VLCAD) X X (VLCAD only) X *Medium-Chain Acyl CoA Dehydrogenase Deficiency (MCADD) X X X *Short chain acyl CoA dehydrogenase deficency (SCAD) X X *Trifunctioinal Protein (TFP) Deficiency X X Peroxisomal disorders (includes Adrenoleukodystrophy, Mevalonate kinase deficiency, 277.86 Zellweger syndrome, Rhizomelic chrondrodysplasia punctata) X X X (Zellweger) Disorders of mitochondrial metabolism (includes deficiencies, syndromes and disorders 277.87 listed below**) X X X **2-Ketoglutarate Dehydrogenase Deficiency X X **Complex I, II, III, IV, V deficiencies X X **Dihydrolipoyl Dehydrogenase deficiency X X **Kearns-Sayre syndrome X X X **Oxidative Phosphorylation Disorders X X 2 Child Health Programs Eligibility Conditions 2011-2012 DIAGNOSES BY PROGRAM CMS BCW FIRST CARE NEWBORN SCREENING HEARING CATEGORIES, CODES, DIAGNOSES: **MELAS: Mitochondrial encephalomyopathy/lactic acidosis & strokelike episodes X X **MERRF: Myoclonic epilepsy with ragged red fibers X X X **NARP: Neurogenic weakness, ataxia, retinitis pigmentose X X 277.9 Unspecified disorder of metabolism (includes Enzymopathy NOS) X 279.11 DiGeorge’s syndrome X X to be added X 280-289: DISEASES OF THE BLOOD AND BLOOD-FORMING ORGANS 282 Herediatary hemolytic anemias X Other hemolytic anemias due to enzyme deficiency (includes Triosephosphate Isomerase 282.3 Deficiency/TPI) X X 282.4 Thalessemia X X 282.6 Sickle-cell disease X X X 282.7 Other hemoglobinopathies X X 286 Coagulation defects X 290-319: MENTAL DISORDERS 299.00 Autistic disorder current or active state X 299.10 Childhood disintegrative disorder current or active state X Other specified pervasive developmental disorders current or active state (includes 299.80 Asperger's disorder) X Unspecified pervasive developmental disorder current or active state (Includes Pervasive 299.90 Developmental Disorder NOS/PDD-NOS) X 320-389: DISEASES OF THE NERVOUS SYSTEM AND SENSE ORGANS 320 Bacterial Meningitis (for BCW: with Neurological sequelae/Severe neurological insult) X X 321 Meningitis due to other organisms X 323.9 Unspecified cause of encephalitis X Leukodystrophy (Includes Krabbe's disease, Pelizaeus-Merzbacher disease, Canavan 330.0 disease) X X Cerebral lipidoses (includes Sandhoff disease, Batten disease, Tay-Sachs, 330.1 Gangliosidosis/GM1, GM2) X X X 330.3 Cerebral degeneration of childhood in other diseases classified elsewhere X Other specified cerebral degenerations in childhood (includes Leigh's disease, Rett's 330.8 syndrome) X X X 330.9 Unspecified cerebral degeneration in childhood X 331.3 Communicating hydrocephalus X X X 331.4 Obstructive hydrocephalus X X X 331.9 Cerebral degeneration unspecified (includes Cortical atrophy) X X X Other extrapyramidal disease and abnormal movement disorders (includes Hallervorden- 333.0 Spatz syndrome, Huntington's Chorea) X X (Hallevorden-Spatz) 335.0 Werdnig-Hoffmann Disease (includes Infantile Spinal Muscular Atrophy) X X 335.11 Kugelberg-Welander disease X X 342.00 Flaccid hemiplegia and hemiparesis affecting unspecified side X 342.01 Flaccid hemiplegia and hemiparesis affecting dominant side X 342.02 Flaccid hemiplegia and hemiparesis affecting nondominant side X 342.1 Spastic hemiplegia and hemiparesis affecting unspecified side X 342.11 Spastic hemiplegia and hemiparesis affecting dominant side X 342.12 Spastic hemiplegia and hemiparesis affecting nondominant side X 342.80 Other specified hemiplegia and hemiparesis affecting unspecified side X 3 Child Health Programs Eligibility Conditions 2011-2012 DIAGNOSES BY PROGRAM CMS BCW FIRST CARE NEWBORN SCREENING HEARING CATEGORIES, CODES, DIAGNOSES: 342.81 Other specified hemiplegia and hemiparesis affecting dominant side X 342.82 Other specified hemiplegia and hemiparesis affecting nondominant side X 342.90 Unspecified hemiplegia and hemiparesis affecting unspecified side X 342.91 Unspecified hemiplegia and hemiparesis affecting dominant side X 342.92 Unspecified hemiplegia and hemiparesis affecting nondominant side X 343.0 Congenital diplegia (includes Congenital paraplegia) X X 343.1 Congenital hemiplegia X X 343.2 Congential quadriplegia X X 343.3 Congenital monoplegia X X 343.4 Infantile hemiplegia X X 343.8 Other specified infantile cerebral palsy X X X 343.9 Infantile cerebral palsy unspecified X X X 344.00 Quadriplegia unspecified X 344.01 Quadriplegia c1-c4 complete X 344.02 Quadriplegia c1-c4 incomplete X 344.03 Quadriplegia c5-c7 complete X 344.04 Quadriplegia c5-c7 incomplete X 344.09 Other quadriplegia X 344.1 Paraplegia X X 344.2 Diplegia of upper limbs X X 344.30 Monoplegia of lower limb affecting unspecified side X X 344.31 Monoplegia of lower limb affecting dominant side X X 344.32 Monoplegia of lower limp affecting nondominant side X X 344.40 Monoplegia of upper limb affecting unspecified side X X 344.41 Monoplegia of upper limb affecting dominant side X X 344.42