Neurofeedback

POLICY NUMBER

L.2.01.441

DESCRIPTION

Neurofeedback describes techniques for providing feedback about neuronal activity, as measured by electroencephalogram biofeedback, functional magnetic resonance imaging, or near-infrared spectroscopy, to teach patients to self-regulate brain activity. Neurofeedback may use several techniques in an attempt to normalize unusual patterns of brain function in patients with various psychiatric and central nervous system disorders.

Disorders of the Central Nervous System

Various disorders involve abnormal brain activity, including autism spectrum disorder, insomnia and sleep disorders, learning disabilities, Tourette syndrome, traumatic brain injury, seizure disorders, premenstrual dysphoric disorder, menopausal hot flashes, depression, stress management, panic and anxiety disorders, posttraumatic stress disorder, substance abuse disorders, eating disorders, migraine headaches, stroke, Parkinson disease, fibromyalgia, tinnitus, and attention-deficit/hyperactivity disorder.

TreatmentNeurofeedback is being investigated for the treatment of a variety of disorders. Neurofeedback may be conceptualized as a type of biofeedback that has traditionally used the electroencephalogram (EEG) as a source of feedback data. Neurofeedback differs from established forms of biofeedback in that the information fed back to the patient (via EEG tracings, functional magnetic resonance imaging, near-infrared spectroscopy) is a direct measure of global neuronal activity, or brain state, compared with feedback of the centrally regulated physiologic processes, such as tension of specific muscle groups or skin temperature. The patient may be trained to increase or decrease the prevalence, amplitude, or frequency of specified EEG waveforms (e.g., alpha, beta, theta waves), depending on the changes in brain function associated with the particular disorder. It has been proposed that training of slow cortical potentials (SCPs) can regulate cortical excitability and that using the EEG as a measure of central nervous system functioning can help train patients to modify or control their abnormal brain activity. Upregulating or downregulating neural activity with real-time feedback of functional magnetic resonance imaging signals is also being explored.

Two EEG-training protocols (training of slow cortical potentials (SCPs) and theta/beta training) are typically used in children withattention-deficit/hyperactivity disorder. For training of SCPs, surface-negative and surface-positive SCPs are generated over the sensorimotor cortex. Negative SCPs reflect increased excitation and occur during states of behavioral or cognitive preparation, while positive SCPs are thought to indicate a reduction of cortical excitation of the underlying neural networks and appear during behavioral inhibition. In theta/beta training, the goal is to decrease activity in the EEG theta band (4 to 8 hertz [Hz]) and increase activity in the EEG beta band (13 to 20 Hz), corresponding to an alert and focused but relaxed state. Alpha-theta neurofeedback is typically used in studies on substance abuse. Neurofeedback protocols for depression focus on alpha interhemispheric asymmetry and theta/beta ratio within the left prefrontal cortex. Neurofeedback for epilepsy has focused on sensorimotor rhythm up-training (increasing 12-15 Hz activity at motor strip) or altering slow cortical potentials. It has been proposed that learned alterations in EEG patterns in epilepsy are aresult of operant conditioning and are not conscious or voluntary. A variety of protocols have been described for the treatment of migraine headaches.

A number of EEG-feedback systems (EEG hardware and computer software programs) have been cleared for marketing by the U.S. Food and Drug Administration (FDA) through the 510(k) process. For example, the BrainMaster™ 2E (BrainMaster Technologies) is “...indicated for relaxation training using alpha EEG Biofeedback. In the protocol for relaxation, BrainMaster™ provides a visual and/or auditory signal that corresponds to the patient’s increase in alpha activity as an indicator of achieving a state of relaxation.” Although devices used during neurofeedback may be subject to FDA regulation, the process of neurofeedback itself is a procedure, and, therefore, not subject to FDA approval.

POLICY

Neurofeedback is considered investigational.

POLICY EXCEPTIONS

None

POLICY GUIDELINES

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 HISTORY

11/2002: Approved by Medical Policy Advisory Committee (MPAC).

8/26/2005: Code Reference section reviewed, no changes.

8/31/2006: Policy reviewed, no changes.

6/19/2009: Policy reviewed, no changes.

6/26/2009: Policy Description section updated.

09/09/2010: Policy description updated to add information regarding neurofeedback for epilepsy. Policy statement unchanged.

09/23/2011: Policy reviewed. Policy description updated; policy statement unchanged.

10/23/2013: Policy review; no changes.

08/15/2014: Policy reviewed; description updated. Policy statement unchanged.

08/17/2015: Medical policy revised to add ICD-10 codes.

10/26/2015: Policy description updated regarding devices. Policy statement unchanged. Investigative definition updated in policy guidelines section.

03/29/2016: Policy description updated. Policy statement unchanged.

06/01/2016: Policy number A.2.01.28 added.

03/08/2017: Policy description updated. Policy statement unchanged.

06/27/2018: Policy description updated regarding disorders of the central nervous system. Policy statement unchanged.

07/01/2019: Policy reviewed; no changes.

07/13/2020: Policy reviewed; no changes.

08/25/2021: Policy reviewed; no changes.

07/11/2022: Policy reviewed; no changes.

03/31/2023: Code Reference section updated to add new HCPCS code E1905, effective 04/01/2023.

07/18/2023: Policy reviewed; no changes.

10/15/2024: Policy reviewed. Policy statement unchanged. Policy number changed from "A.2.01.28" to "L.2.01.441."

SOURCE(S)

Blue Cross Blue Shield Association Policy # 2.01.28

CODE REFERENCE

This may not be a comprehensive list of procedure codes applicable to this policy.

Non-Covered Codes

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