Sensory Stimulation for Coma Patients

POLICY NUMBER

L.2.01.421

DESCRIPTION

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.

POLICY

Sensory stimulation for coma patients 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

7/1994: 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.

07/23/2015: Code Reference section updated for ICD-10. Removed deleted CPT codes 0160T and 0161T.

04/26/2016: Policy Guidelines updated to revise investigative definition.

06/06/2016: Policy number L.2.01.421 added.

06/30/2023: Policy reviewed; no changes.

06/24/2024: Policy reviewed; no changes.

08/04/2025: Policy reviewed. Policy statement unchanged. Sources updated.

SOURCE(S)

1. Blue Cross Blue Shield Association policy # 2.01.24

2. Zuo J, Tao Y, Liu M, Feng L, Yang Y, Liao L. The effect of family-centered sensory and affective stimulation on comatose patients with traumatic brain injury: A systematic review and meta-analysis. Int J Nurs Stud. 2021 Mar;115:103846. doi: 10.1016/j.ijnurstu.2020.103846. Epub 2020 Dec 7. PMID: 33485101. Accessed May 2025.

CODE REFERENCE

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

Investigational Codes

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