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Sensory stimulation is intended to promote awakening and enhance the rehabilitative potential of coma patients. Protocols may involve stimulation of any or all of the following senses: visual, auditory, olfactory, gustatory, cutaneous, and kinesthetic. Various stimuli may be used for each sense. Protocols may differ with respect to who performs the stimulation and where. Professionals include: nurses, occupational therapists, physical therapists, and speech-language therapists. In some cases, family members may be trained in the techniques and are given primary responsibility for providing the therapy. Treatment may be delivered in the hospital, the patient's home, or a nursing home.
Sensory stimulation for coma patients is considered investigational.
Investigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary.
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language
POLICY HISTORY7/1994: Approved by Medical Policy Advisory Committee (MPAC)
4/1997: Reviewed by MPAC; investigational status maintained
2/11/2002: Investigational definition added
5/7/2002: Type of Service and Place of Service deleted
11/5/2003: Code Reference section completed
3/11/2004: Sources updated
6/23/2004: Policy reviewed
5/8/2006: Policy reviewed, no changes
1/4/2007: Code reference section updated per the 2007 CPT/HCPCS revisions
12/31/2008: Policy reviewed, no changes
03/07/2011: Added new HCPCS codes 90867 and 90868 to the Code Reference section.
SOURCE(S)Blue Cross Blue Shield Association policy # 2.01.24
CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy.