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Biofeedback is a training procedure aimed at helping a patient achieve control over a physiologic process. The central feature involves providing the patient with auditory or visual signals from a monitoring device. These signals are the feedback which signify activity from a physiologic variable that is supposed to be related to a given disorder.
Biofeedback is often administered concurrently with relaxation training. Biofeedback treatment regimens begin with a training phase in which the patient receives feedback from the monitoring device. After the patient has achieved success in controlling the physiologic variable and/or clinical symptoms, a long-term maintenance phase is initiated. During maintenance, the subject is often expected to learn to control the condition without feedback.
Biofeedback is not eligible for coverage. All uses are considered investigational.
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language.
Investigative is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized as a generally accepted standard of good medical practice for the treatment of the condition being treated and; therefore, is not considered medically necessary. For the definition of Investigative, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of medical practitioners practicing in relevant clinical areas and any other relevant factors. In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting.
POLICY HISTORY10/1992: Approved by Medical Policy Advisory Committee (MPAC)
2/14/2002: Investigational definition added
4/18/2002: Type of Service and Place of Service deleted
5/23/2002: Code Reference section completed
6/5/2002: Code Reference section updated
3/25/2004: Reviewed by MPAC, remains investigational for all indications, Sources updated
5/19/2004: Code Reference section updated, CPT code 90875, 90876 added
8/14/2009: Policy reviewed, no changes
09/09/2010: Policy reviewed; no changes.
12/30/2010: Policy reviewed; no changes.
11/10/2011: Policy reviewed; no changes.
04/18/2013: Policy reviewed; no changes.
03/12/2014: Policy reviewed; no changes.
08/21/2015: Code Reference section updated for ICD-10.
01/05/2016: Investigative definition updated in policy guidelines section.
02/10/2016: Policy reviewed; no changes.
06/01/2016: Policy number L.2.01.400 added.
SOURCE(S)Blue Cross Blue Shield Association policy #2.01.27
Blue Cross Blue Shield Association policy #2.01.29
Blue Cross Blue Shield Association policy #2.01.30
Blue Cross Blue Shield Association policy #2.01.53
Blue Cross Blue Shield Association policy #2.01.64
Hayes Medical Technology Directory
CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy.
CPT copyright American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.