Blue Cross Blue Shield of Minnesota Medical Policy

 
 

Medical Policy:
X-29-013
Topic:
Neurofeedback
Section:
Behavioral Health
Effective Date:
November 25, 2024
Issued Date:
November 25, 2024
Last Revision Date:
February 2020
Annual Review:
February 2024
 
 

Neurofeedback describes techniques of providing information about neuronal activity as measured by electroencephalogram (EEG) or functional magnetic resonance imaging (fMRI), to teach patients to self-regulate brain activity. The techniques attempt to normalize patterns of brain function in patients with a variety of disorders. These include but are not limited to autism spectrum disorder, learning disabilities, Tourette syndrome, traumatic brain injury, seizure disorders, menopausal hot flashes, panic and anxiety disorders, fibromyalgia, tinnitus, substance abuse disorders, eating disorders, depression, stress management, migraine headaches, stroke, Parkinson’s disease, premenstrual dysphoric disorder, posttraumatic stress disorder, and sleep disorders.

A number of EEG biofeedback systems (EEG hardware and computer software programs) have been cleared for marketing by the U.S. Food and Drug Administration (FDA) through the 510(k) process. For example, the BrainMaster™ 2E is indicated for relaxation training using alpha EEG Biofeedback. In the protocol for relaxation, the BrainMaster™ provides a visual and/or auditory signal that corresponds to the patient's increase in alpha activity as an indicator of achieving a state of relaxation. Although devices used during neurofeedback may be subject to FDA regulation, the process of neurofeedback itself is a procedure and, therefore, not subject to FDA approval. 

 

This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records.

Policy Position Coverage is subject to the specific terms of the member's benefit plan.

Neurofeedback is considered EXPERIMENTAL/INVESTIGATIVE for all indications due to a lack of clinical evidence demonstrating an impact on improved health outcomes.

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Denial Statements

No additional statements.



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Blue Cross and Blue Shield of Minnesota medical policies apply generally to all Blue Cross and Blue Plus plans and products. Benefit plans vary in coverage and some plans may not provide coverage for certain services addressed in the medical policies. When determining coverage, reference the member’s specific benefit plan, including exclusions and limitations.

Medicaid products may provide different coverage for certain services, which may be addressed in different policies. For Minnesota Health Care Program (MHCP) policies, please consult the MHCP Provider Manual website.

Medicare products may provide different coverage for certain services, which may be addressed in different policies. For Medicare National Coverage Determinations (NCD), Local Coverage Determinations (LCD), and/or Local Coverage Articles, please consult CMS, National Government Services, or CGS websites. 

Note that services with specific coverage criteria may be reviewed retrospectively to determine if criteria are being met. Retrospective denial of claims may result if criteria are not met.

Blue Cross and Blue Shield of Minnesota reserves the right to revise, update and/or add to its medical policies at any time without notice. Codes listed on this policy are included for informational purposes only and are subject to change without notice. Inclusion or exclusion of a code does not constitute or imply member coverage or provider reimbursement. 

These guidelines are the proprietary information of Blue Cross and Blue Shield of Minnesota. Any sale, copying or dissemination of the medical policies is prohibited; however, limited copying of medical policies is permitted for individual use.

Acknowledgements:

CPT® codes copyright American Medical Association® 2023. All rights reserved.

CDT codes copyright American Dental Association® 2023. All rights reserved.