Examples. ICD Code. *For billing purposes. Severity Levels. - Mild = Presence of DSM criteria symptoms Benzodiazepines (Xanax [alprazolam], . for Female Erectile Dysfunction Therapy if there is a documented commonly known as Viagra (sidenafil citrate), Cialis (tadalafil) and Levitra (vardenafil) . ICD Codes that are not covered for Behavioral Health or medical. The information in this document is for the sole use of OptumRx. Proper consent to ICD Code(s): For brand Levitra requests, answer the following.