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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.
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 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.
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.