BlueCross BlueShield of Tennessee Medical Policy Manual

Biofeedback and Neurofeedback

Biofeedback policy statements do not apply to Medicare Advantage.

DESCRIPTION

Biofeedback is a technique used to train an individual in self-regulation of a physiological processes not generally considered to be under voluntary control.  Various measuring, recording instruments and monitors may be used in the training. Biofeedback training is done in individual sessions, group sessions, alone or with other behavioral therapies designed to teach relaxation. Biofeedback has been proposed as a treatment for a variety of conditions including anxiety, headache, urinary and fecal incontinence, constipation, pain and temporomandibular joint dysfunction.

Neurofeedback describes techniques of providing feedback about neuronal activity, as measured by electroencephalogram (EEG), functional magnetic resonance imaging or near-infrared spectroscopy, to teach individuals to self-regulate brain activity. Neurofeedback differs from traditional forms of biofeedback in that the information fed back to the individual is a direct measure of global neuronal activity, or brain state. Purportedly, the individual may be trained to either increase or decrease the prevalence, amplitude or frequency of specified EEG waveforms, depending on the changes in brain function associated with the particular disorder.  Neurofeedback is being explored for the treatment of a variety of disorders including attention deficit/hyperactivity disorder, Tourette syndrome, autism spectrum disorder, traumatic brain injury, seizure disorders, anxiety disorders, fibromyalgia, tinnitus, substance abuse disorders, depression, and as a stress management technique.

POLICY

MEDICAL APPROPRIATENESS

IMPORTANT REMINDERS

Biofeedback policy statements do not apply to Medicare Advantage.

ADDITIONAL INFORMATION

There is a lack of scientific evidence to determine the effect of health outcomes or clinical efficacy for all conditions not listed as medically appropriate above.

SOURCES 

Agency for Healthcare Research and Quality. (2016, June) Evidence-based Practice Center Systematic Review Protocol: Attention Deficit Hyperactivity Disorder (ADHD). Retrieved October 11, 2017 from www.effectivehealthcare.ahrq.gov.

American Academy of Neurology. (2000). Practice parameter: evidence-based guidelines for migraine headache (an evidence-based review). Neurology. Retrieved September 20, 2016 from  http://www.neurology.org/content/55/6/754.full.pdf+html.

American Academy of Pediatrics (2011) ADHD: Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Retrieved October 111, 2017 from http://pediatrics.aappublications.org.

American College of Physicians (2017, April) Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline. Retrieved October 11, 2017 from the National Guideline Clearinghouse (NCG: 011196).

American Gastroenterological Association. (2013). American Gastroenterological Association medical position statement on constipation. Retrieved February 25, 2013 from http://www.gastrojournal.org.

Arnold, E., Lofthouse, N., Hersch, S., Pan, X., Hurt, E., Bates, B., et al. (2017, July) EEG neurofeedback for attention-deficit/hyperactivity disorder: double-blind sham-controlled randomized pilot feasibility trial. Journal of Attention Disorders, 17 (5), 410-419. (Level 2 evidence)

BlueCross BlueShield Association. Medical Policy Reference Manual. (2:2017). Temporomandibular joint dysfunction (2.01.21). Retrieved October 11, 2017 from BlueWeb. (32 articles and/or guidelines reviewed)

BlueCross BlueShield Association. Medical Policy Reference Manual. (1:2017). Biofeedback as a treatment of urinary incontinence in adults (2.01.27). Retrieved October 11, 2017 from BlueWeb. (21 articles and/or guidelines reviewed)

BlueCross BlueShield Association. Medical Policy Reference Manual. (2:2017). Neurofeedback (2.01.28). Retrieved October 11, 2017 from BlueWeb. (34 articles and/or guidelines reviewed)

BlueCross BlueShield Association. Medical Policy Reference Manual. (5:2015). Biofeedback as a treatment of headache (2.01.29). Retrieved October 11, 2017 from BlueWeb. (24 articles and/or guidelines reviewed)

BlueCross BlueShield Association. Medical Policy Reference Manual. (11:2015). Biofeedback as a treatment of chronic pain (2.01.30). Retrieved October 11, 2017 from BlueWeb. (26 articles and/or guidelines reviewed)

BlueCross BlueShield Association. Medical Policy Reference Manual. (8:2017). Biofeedback for miscellaneous indications (2.01.53). Retrieved October 11, 2017 from BlueWeb. (37 articles and/or guidelines reviewed)

BlueCross BlueShield Association. Medical Policy Reference Manual. (11:2016). Biofeedback as a treatment of fecal incontinence or constipation (2.01.64). Retrieved October 11, 2017 from BlueWeb. (22 articles and/or guidelines reviewed)

Centers for Medicare & Medicaid Services. CMS.gov. NCD for biofeedback therapy (30.1). Retrieved December 7, 2015 from http://www.cms.gov.

Centers for Medicare & Medicaid Services. CMS.gov. NCD for biofeedback therapy for the treatment of urinary incontinence (30.1.1).  Retrieved December 4, 2015 from http://www.cms.gov.

National Institute for Health and Care Excellence. (2007, June). Clinical guidance: Faecal incontinence in adults: management. Retrieved October 11, 2017 from www.nice.org/uk.

National Institute for Health and Care Excellence. (2010, May). Clinical guidance: Constipation in children and young people: diagnosis and management. Retrieved October 11, 2017 from www.nice.org/uk.

National Institute for Health and Care Excellence. (2012). Clinical guidance: urinary incontinence in neurological disease: assessment and management. Retrieved September 19, 2016 from www.nice.org/uk.

National Institute for Health and Care Excellence. (2013, September). Clinical guidance: Urinary incontinence in women: management. Retrieved October 11, 2017 from www.nice.org/uk.

U. S. Food and Drug Administration. (2005, April). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K050483. Retrieved May 4, 2010 from http://www.accessdata.fda.gov.

U. S. Food and Drug Administration. (2007, June). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K070425. Retrieved October 31, 2011 from http://www.accessdata.fda.gov.

U. S. Food and Drug Administration. (2008, February). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K073557. Retrieved October 31, 2011 from http://www.accessdata.fda.gov.

ORIGINAL EFFECTIVE DATE:  4/1980

MOST RECENT REVIEW DATE:  11/9/2017

ID_BT

Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.

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