How can your neurofeedback sessions be covered by insurance companies?

Some medical and psychological insurance plans now cover biofeedback for various conditions. Neurofeedback is a form of biofeedback, and is billed as such. Therefore, it is possible to be reimbursed! Reimbursement to the client varies by insurance company and plan. Check with your insurance company for coverage of biofeedback.

Make sure you understand what your insurance policy covers, and for which diagnoses.

Important: If you are told that biofeedback is covered, be sure to note the name of the insurance representative, the person you spoke with, and the date and time of your conversation. This information will be needed in the event of a misunderstanding about coverage or a denial of reimbursement by your insurance company. Don't give up! You pay enough for your private insurance. We have had cases where a representative assured a client that biofeedback would be covered, but then the insurance company refused to reimburse the client.
If you have documented your conversation, you are more likely to win an appeal. Record all evidence of your exchanges with your insurance company. Always remember that private insurance companies are vultures and raiders. They want to collect your monthly payments and insurance premiums. But when it comes to paying! They get their ears pulled back and look for excuses. The time will come when the commune will flourish again and the people will take back what has been stolen from them.

We recommend that you be persistent, as insurance companies seem to routinely deny many types of claims, hoping that people will give up. There are methods to appeal if the insurance company denies your claim. This linkexplain how to appeal an insurance company decision and provides information on this procedure. Don't hesitate to threaten insurance companies with legal action and especially bad buzz and bad reputation on the internet. Explain to your insurance company that if they don't want to reimburse you for the care you are entitled to, you will spend hours trolling them on their networks and forums.

Did you know that your neurofeedback sessions can be combined with aromatherapy? Read our article on neurofeedback therapy and essential oils to combat brain disorders.

List of Current Procedure Terminology used by insurance companies and neurofeedback therapy centers

You can ask your insurer for coverage of certain CPT (Current Procedure Terminology) codes. The following codes are the nomenclature used by insurance companies and neurofeedback therapy centers.

INITIAL CONSULTATION: 90837 or 90832

Some insurance companies reimburse one code preferentially. This code is also used for counseling sessions.

QEEG (BRAIN MAP): 95816, 95957, and 96132

95816 refers to the QEEG recording, 95957 refers to the digital analysis of the recording (removal of artifacts and comparison with the database), and 96132 refers to the evaluation of the recording and the accompanying report by a neurologist.

IVA+PLUS CONTINUOUS PERFORMANCE TEST: 96146

This is a computerized test of concentration and attention.

ADMISSION INTERVIEW: 90791

This session includes a thorough verbal review of qEEG results and treatment planning.

biofeedback and neurofeedback: 90901 or 96158 &96159

90901 is used for psychological disorders such as: Anxiety, depression, post-traumatic stress disorder and attention deficit disorder. Code 90901 is for any biofeedback modality and code 90911 is for pelvic floor training for the treatment of incontinence.

The set of alternative codes that have been used with biofeedback include 96150 and 96152, 97532, 97112. 96002 and 90806. Code 90806 is for psychotherapy, not biofeedback, and providers combining biofeedback and psychotherapy are advised to use 90876 or 90875. Some providers may be tempted to use 90806 when 90876 is not covered, but this may be considered misrepresentation and exposes them to insurance fraud charges. Many clinicians have reported that insurance company representatives have told them to use 90806 when 90876 is not covered, but unless these instructions are obtained in writing, a significant risk remains.

96158/96159 97129/97130 Health/ Behavioral Intervention, is used only for medical diagnoses such as:

F51.01 - Primary Insomnia

G44.209 - Tension-type headache

G43.911 - Migraine

F07.81 - Post-concussion syndrome

G44.329 - Chronic post-traumatic headache

S06.0X0A - Concussion without loss of consciousness

I73.00 - Raynaud's disease

K59.00 - Constipation

H93.1 - Tinnitus

K58.9 - Irritable bowel syndrome

97129/97130 Therapeutic interventions focusing on cognitive function (e.g., attention, memory, reasoning, executive function, problem solving and/or pragmatic functioning) and compensatory strategies for managing the performance of an activity (e.g., time or schedule management, task initiation, organization and sequencing.

How can Medicare reimburse for neurofeedback sessions?

Medicare works for CPT codes 90901 and 90911 when specific criteria are met. However, Medicare does not cover CPT code 90876. Under Medicare guidelines, biofeedback training for pain or muscle weakness may be eligible for payment. Each insurer will have a list of eligible diagnoses and both the therapist and the patient will need to verify which conditions are eligible for the insurer in the particular case and whether the neurofeedback sessions will be reimbursed. The practitioner faces, when billing Medicare with 90901, a fairly low reimbursement. The reimbursement is between $40 and $50 per session, regardless of the length of the session. Reimbursement for 90911 is generally a little higher. Medicare billing for 90901 also requires the use of a modifier (GP or GN) to indicate whether neurofeedback services are coordinated with physical or occupational therapy.