90875,90876,**90901
Basic Benefit and Medical Policy
Neurofeedback training as an alternative therapy for children with attention deficit hyperactivity disorder has been established. It may be a useful treatment option when indicated for children through 18 years of age, effective May 1, 2013.
Neurofeedback training for other central nervous system disorders, such as autism spectrum disorder, substance abuse, epilepsy, and insomnia, is experimental. There is a lack of evidence in the peer reviewed published medical literature on the clinical utility and effectiveness of neurofeedback for these conditions.
**Biofeedback was previously established for urinary and fecal incontinencetreatment only.
Group Variations
Not payable for Chrysler, GM, Delphi, the Federal Employee Program®, MPSERS or URMBT groups.
Payment Policy
Payable to an M.D., D.O., fully licensed psychologist or C.L.M.S.W. Services aresubject to all the rules and limitations of the member’s mental health benefit.
Inclusionary Guidelines
- The patient is 18 years of age or younger with a confirmed DSM-IV
- Neurofeedback training is performed by a qualified, licensed healthpractitioner.
Exclusionary Guidelines
- All other central nervous system disorders
- More than 40 neurofeedback sessions