Does insurance pay for neurofeedback or BrainCore Therapy?

Written by Caroline von Fluegge-Chen.

Does insurance pay for neurofeedback or BrainCore Therapy?

Updated Guidelines for Biofeedback Reimbursement from Third Parties.

Ronald Rosenthal, Doctor of Philosophy.

In an ideal world, biofeedback reimbursement for insurance remains inconsistent and unpredictable, and the world we reside in is far from perfect. Nevertheless, we could compile an extensive roster of insurance companies and managed care organizations that have unfailingly covered the costs of biofeedback services.

In order to accurately complete a claim form for billing to third-party payers, we need to provide you with codes based on the combination of payment decisions regarding all procedures and diagnosis codes. Additionally, the claim form will include basic demographic information to identify your client. It is important to remember how third-party reimbursement works in order to try to bring some order to this topic.

The first step in the process is to contact the insurance company and verify coverage. If you want to determine if biofeedback services will be paid for, you will need to call the insurance company. Basic coverage details may be available online, but if you are not in the provider network, copays may be increased and deductibles may be higher. Additionally, you may be restricted to participating providers.

Many insurance companies have long lists of excluded services, and these lists often include biofeedback codes. In cases where the diagnosis code is included in the list of covered conditions, only the procedure codes will be paid. For developmental or psychiatric disorders, counselors and psychologists are only covered when using codes like 90806, which serve as an example of basic procedural codes for mental health.

During a session, not all of the actions performed may accurately represent the fundamental biofeedback codes. Additional approaches could involve guidance, respiratory instruction, relaxation and mindfulness techniques, Feldenkrais exercises, Tai-Chi, yoga, and so forth. The majority of biofeedback practitioners endorse an integrated treatment strategy where biofeedback training is only one component of a comprehensive package. The utilization of these alternative codes reflects the intricate and varied ways in which biofeedback training can be applied. Apart from the aforementioned codes, some practitioners have been utilizing codes from the physical medicine section of the code book or the new health and behavior intervention/assessment codes for billing purposes. These codes pertain to sessions that combine biofeedback with some form of therapy or counseling, with 90875 designated for a 25-minute session and 90876 for a 50-minute session. The 90901 code encompasses any modality of biofeedback, while the 90911 code specifically refers to pelvic floor training for the treatment of incontinence. There exist two exclusive biofeedback codes, namely 90901 and 90911. The set of procedural codes for biofeedback is relatively limited.

Many legitimate cases can be made for the use of these codes in the treatment of patients with chronic medical conditions. These codes recognize the interplay of biopsychosocial factors and the mind/body connection in the expression of disease and health. They are used by psychologists to assess and treat patients primarily with a physical complaint diagnosed by a physician. In 2002, the codes 9615x were released for behavior and health. However, unless specifically instructed, these instructions are not covered when using code 90806, which remains a significant risk in insurance writing. Many clinicians have been told by insurance company representatives that they should not use code 90876 when code 90806 is not covered, leaving them open to charges of insurance fraud and misrepresentation. Some providers may be tempted to use code 90876 despite it not being covered. Providers are advised to use codes 90875 or 90876 for therapy and biofeedback combining, as code 90806 is for biofeedback and not psychotherapy. The alternative set of codes that have been used with biofeedback include 90806, 96002, 97112, 97532, 96152, and 96150.

Some insurance companies require the use of medical diagnosis at times because it has caused problems for psychologists who only use mental health codes.

Speech and language pathologists have traditionally utilized the 97532 code to retrain the cognitive function of patients with cognitive deficits. Neurofeedback providers working with clients with ADHD or TBI have also adopted this code. The 97112 code is used to refer to neuromuscular retraining for movement, balance, or coordination. In rehabilitation settings, surface EMG training can be classified under the 97112 code, which includes some less common techniques. The relatively new code, 96002, represents dynamic surface EMG recording for gait training and other functional activities. The use of this code may facilitate motor control improvement through EMG biofeedback.

Medicare.

Medicare. will pay for CPT codes 90901 and 90911 when specific criteria are met. Medicare. does not reimburse for 90876. Under Medicare. guidelines, biofeedback training for muscular pain or weakness may be eligible for payment. Each carrier will have a list of eligible diagnoses and you would have to check to see what conditions are eligible for your local carrier and whether you can be reimbursed as a provider.

The main concern when billing Medicare. with 90901 is that reimbursement is quite low. The allowance is between $40-50 per session, regardless of the length of the session. The reimbursement for 90911 is typically higher. Billing Medicare. for 90901 also requires the use of a modifier (GP or GN) to indicate whether the services are coordinated with physical therapy or occupational therapy.

All of the Medicare. carriers are now paying for the health and behavior intervention codes. In Florida, the allowance is $97 for the evaluation (96150—1 hour or 4 units) and $89 for individual treatment (96152—1 hour or 4 units).

I don’t have information on Medicare. coverage of 97532. Since the vast majority of clients getting neurofeedback for attention deficit disorder are children, it is highly unlikely that they will have Medicare. for insurance.

As an enrolled participant, you can bill the federal program for biofeedback services provided to injured employees on the job. However, the enrollment process for this program can be tedious. Once you are enrolled, you will receive compensation for biofeedback training through the federal workers’ compensation program (http://owcp.Dol.Acs-inc.Com/portal/main.Do).

Reports of biofeedback reimbursement from Aetna, United, and Delta have been received on the West coast. Despite Blue Cross/Blue Shield’s negative views on biofeedback, several providers have successfully received payment from Blue Cross. Neurofeedback providers have found that having a QEEG brain map is beneficial in obtaining authorization or reimbursement. The documentation provided by AAPB’s Evidence-Based Practice in Biofeedback and Neurofeedback, along with certification by BCIA, has proven to be helpful. While obtaining authorization on a case-by-case basis is often necessary, many providers have achieved reimbursement for biofeedback services from major insurance carriers. It is important to note that giving universal advice in this matter is impossible.

If you are familiar with AAPB or BCIA, you may know that success is important to us. In case you are a provider or manager in the field of relations, if you initially receive a rejection, please contact a supervisor. The restrictions based on the type of licensure may include and the specifics of the contract given often vary widely. It is advisable to verify the coverage for all possible biofeedback codes for all of your patients in your office. The best advice is to be prepared and persistent.