Biofeedback and Neurofeedback

BlueCross BlueShield of Tennessee Medical Policy Manual

Biofeedback policy statements do not apply to Medicare Advantage.

DESCRIPTION

Biofeedback is a technique used to train an individual to control a physiological process. It uses cognitive and behavioral techniques to teach an individual self-regulation of biologic processes. Various measuring and 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, usually the entire program consists of 10 to 20 training sessions which last about 30 minutes each. Biofeedback has been proposed as a treatment for a variety of diseases and disorders including anxiety, headache (e.g., migraine and tension), hypertension, fecal incontinence, urinary incontinence, pain, asthma, Raynaud's disease, insomnia, and temporomandibular joint dysfunction.

Neurofeedback is a process in which an individual learns to increase or decrease specific brain activity using real-life feedback from a scalp electroencephalogram (EEG). During neurofeedback, the individual is seated in a chair facing a computer screen and electrodes are placed on the individual’s scalp. Target brain waves and event-related potentials are recorded and processed by an electroencephalograph and computer and concurrently presented to the individual. Individuals are encouraged to increase desired brain activity and decrease undesired activity by either increasing or decreasing 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. Sessions last between 30 and 60 minutes and between 25 and 50 sessions are usually scheduled. A therapist is typically present to facilitate learning and individuals are instructed to practice strategies at home between sessions. The neurofeedback technology is being explored for the treatment of a variety of disorders including attention deficit/hyperactivity disorder (ADHD), learning disabilities, Tourette syndrome, autism spectrum disorder traumatic brain injury, seizure disorders, menopausal hot flashes, panic and anxiety disorders, fibromyalgia, tinnitus, substance abuse disorders, depression, stress management, migraine headaches, and sleep disorders.

POLICY

Biofeedback training or therapy and neurofeedback for the treatment of all conditions/diseases are considered investigational.

IMPORTANT REMINDERS

Any specific products referenced in this policy are just examples and are intended for illustrative purposes only. It is not intended to be a recommendation of one product over another, and is not intended to represent a complete listing of all products available. These examples are contained in the parenthetical e.g. statement.

We develop Medical Policies to provide guidance to Members and Providers. This Medical Policy relates only to the services or supplies described in it. The existence of a Medical Policy is not an authorization, certification, explanation of benefits or a contract for the service (or supply) that is referenced in the Medical Policy. For a determination of the benefits that a Member is entitled to receive under his or her health plan, the Member's health plan must be reviewed. If there is a conflict between the Medical Policy and a health plan, the express terms of the health plan will govern.

Biofeedback policy statements do not apply to Medicare Advantage.

ADDITIONAL INFORMATION

There is a lack of scientific evidence regarding biofeedback and the neurofeedback technology that permits conclusions concerning the effect of health outcomes or clinical efficacy of all conditions and diseases.

SOURCES

American Academy of Neurology. (2000). Practice parameter: Evidence-based guidelines for migraine headache (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology. Retrieved May 10, 2010 from http://www.aan.com/professionals/practice/pdfs/gl0085.pdf.

BlueCross BlueShield Association. Medical Policy Reference Manual. (7:2011). Temporomandibular joint dysfunction (2.01.21). Retrieved October 31, 2011 from BlueWeb. (13 articles and/or guidelines reviewed)

BlueCross BlueShield Association. Medical Policy Reference Manual. (7:2011). Biofeedback as a treatment of urinary incontinence in adults (2.01.27). Retrieved October 31, 2011 from BlueWeb. (17 articles and/or guidelines reviewed)

BlueCross BlueShield Association. Medical Policy Reference Manual. (8:2011). Neurofeedback (2.01.28). Retrieved October 28, 2011 from BlueWeb. (27 articles and/or guidelines reviewed)

BlueCross BlueShield Association. Medical Policy Reference Manual. (4:2011). Biofeedback as a treatment of headache (2.01.29). Retrieved October 31, 2011 from BlueWeb. (23 articles and/or guidelines reviewed)

BlueCross BlueShield Association. Medical Policy Reference Manual. (3:2011). Biofeedback as a treatment of chronic pain (2.01.30). Retrieved October 31, 2011 from BlueWeb. (21 articles and/or guidelines reviewed)

BlueCross BlueShield Association. Medical Policy Reference Manual. (8:2011). Biofeedback for miscellaneous indications (2.01.53). Retrieved October 31, 2011 from BlueWeb. (17 articles and/or guidelines reviewed)

BlueCross BlueShield Association. Medical Policy Reference Manual. (10:2010). Biofeedback as a treatment of fecal incontinence or constipation (2.01.64). Retrieved October 31, 2011 from BlueWeb. (20 articles and/or guidelines reviewed)

Bols, E. M., Berghmans, B. C., Hendriks, E. J., de Bie, R. A., Melenhorst, J., van Gemert, W. G., et al. (2007). A randomized physiotherapy trial in patients with fecal incontinence: Design of the PhysioFIT-study. BMC Public Health, 7, 355. (Level 2 Evidence - Industry sponsored)

Campbell, J. K., Penzien, D. B., Wall, E. M., & U. S. Headache Consortium. (2000). Evidenced-based guidelines for migraine headache: Behavioral and physical treatments. Retrieved May 4, 2010 from http://www.aan.com/professionals/practice/pdfs/gl0089.pdf.

Chiarioni, G., Whitehead, W. E., Pezza, V., Morelli, A., & Bassotti, G. (2006). Biofeedback is superior to laxatives for normal transit constipation due to pelvic floor dyssynergia. Gastroenterology, 130 (3), 657-664. (Level 3 Evidence - Independent study)

Complete Guide to Medicare Coverage Issues [Computer software]. (2011, November). Biofeedback therapy (NCD 30.1, p. 2-30). Ingenix.

Complete Guide to Medicare Coverage Issues [Computer software]. (2011, November). Biofeedback therapy for the treatment of urinary incontinence (NCD 30.1.1, p. 2-30). Ingenix.

Demirturk, F., Akbayrak, T., Karakaya, I. C., Yuksel, I., Kirdi, N., Demirturk, F., et al. (2008). Interferential current versus biofeedback results in urinary stress incontinence. Swiss Medical Weekly, 138 (21-22), 317-321. (Level 3 Evidence - Independent study)

ECRI Institute. Health Technology Information Service. Evidence Reports. (2007, February). Neurofeedback for treatment of attention deficit hyperactivity disorder. Retrieved October 31, 2011 from ECRI Institute. (75 articles and/or guidelines reviewed)

ECRI Institute. Health Technology Information Service. Evidence Reports. (1998, September). Biofeedback for the treatment of constipation in children. Retrieved October 31, 2011 from ECRI Institute. (32 articles and/or guidelines reviewed)

ECRI Institute. Health Technology Information Service. Evidence Reports. (1998, October). Biofeedback for the treatment of fecal incontinence. Retrieved October 31, 2011 from ECRI Institute. (40 articles and/or guidelines reviewed)

Gevensleben, H., Holl, B., Albrecht, B., Schlamp, D., Kratz, O., Studer, P., et al. (2010). Neurofeedback training in children with ADHD: 6-month follow-up of a randomised controlled trial. European Child & Adolescent Psychiatry, 19 (9), 715-724. (Level 4 Evidence - Independent study)

Glick, R. M., & Greco, C. M. (2010). Biofeedback and primary care. Primary Care Clinics in Office Practice, 37 (1), 91-103.

Hammond, D. C., Bodenhamer-Davis, G., Gluck, G., Stokes, D., Harper, S. H., Trudeau, D., et al. (2011). Standards of practice for neurofeedback and neurotherapy: A position paper of the International Society for Neurofeedback & Research. Journal of Neurotherapy, 15 (1), 54-64.

Heymen, S., Scarlett, Y., Jones, K., Ringel, Y., Drossman, D., & Whitehead, W. E. (2007). Randomized, controlled trial shows biofeedback to be superior to alternative treatments for patients with pelvic floor dyssynergia-type constipation. Diseases of the Colon and Rectum, 50 (4), 428-441. (Level 2 Evidence - Industry sponsored)

Lansbergen, M. M., van Dongen-Boomsma, M., Buitelaar, J. K., & Slaats-Willemse, D. (2011). ADHD and EEG-neurofeedback: A double-blind randomized placebo-controlled feasibility study. Journal of Neural Transmission, 118 (2), 275-284. (Level 4 Evidence - Industry sponsored)

Locke, G. R., Pemberton, J. H., & Phillips, S. F. (2000). AGA technical review on constipation. Gastroenterology, 119 (6), 1766-1778.

Locke, G. R., Pemberton, J. H., & Phillips, S. F. (2000). American Gastroenterological Association medical position statement: Guidelines on constipation. Gastroenterology, 119 (6), 1761-1766.

Moravec, C. S., & McKee, M. G. (2011). Biofeedback in the treatment of heart disease. Cleveland Clinic Journal of Medicine, 78 (Suppl. 1), S20-S23.

Myung, S. J. (2010). Biofeedback therapy in constipation and fecal incontinence. Journal of Neurogastroenterology and Motility, 16 (2), 110-112.

National Guideline Clearinghouse. (2006). Clinical practice guidelines for biofeedback. Retrieved October 31, 2011 from http://www.guidelines.gov.

National Guideline Clearinghouse. (2008, March). Prevention of fecal and urinary incontinence in adults. Retrieved May 4, 2010 from http://www.guidelines.gov.

National Guideline Clearinghouse. (2010). Management of children with vesicoureteral reflux and bladder/bowel dysfunction. In: Management and screening of primary vesicoureteral reflux in children: AUA guideline. Retrieved October 31, 2011 from http://www.guidelines.gov.

National Guideline Clearinghouse. (2010, March). Diagnosis and management of attention deficit hyperactivity in primary care for school-age children and adolescents. Retrieved October 31, 2011 from http://www.guidelines.gov.

Norton, C. (2008). Fecal incontinence and biofeedback therapy. Gastroenterology Clinics of North America, 37 (3), 587-604.

Rao, S. S. (2008). Dyssynergic defecation and biofeedback therapy. Gastroenterology Clinics of North America, 37 (3). 569-586.

Rao, S. S., Seaton, K., Miller, M., Brown, K., Nygaard, I., Stumbo, P., et al. (2007). Randomized controlled trial of biofeedback, sham feedback, and standard therapy for dyssynergic defecation. Clinical Gastroenterology and Hepatology, 5 (3), 331-338. (Level 2 Evidence - Industry sponsored)

Rao, S. S., Valestin, J., Brown, C. K., Zimmerman, B., & Schulze, K. (2010). Long-term efficacy of biofeedback therapy for dyssynergic defecation: Randomized controlled trial. The American Journal of Gastroenterology, 105 (4), 890-896. (Level 3 Evidence - Independent study)

Stokes, D. A., & Lappin, M. S. (2010). Neurofeedback and biofeedback with 37 migraineurs: A clinical outcome study. Behavioral and Brain Functions, 6 (9). 1-10. (Level 4 Evidence - Independent study)

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/cdrh_docs/pdf5/K050483.pdf.

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/cdrh_docs/pdf7/K070425.pdf.

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/cdrh_docs/pdf7/K073557.pdf.

Winifred S. Hayes, Inc. Medical Technology Directory. (2007, July; last update search June 2011). Biofeedback as an adjunct to physical therapy for recovery after stroke. Retrieved October 31, 2011 from www.Hayesinc.com/subscribers. (26 articles and/or guidelines reviewed)

Winifred S. Hayes, Inc. Medical Technology Directory. (2009, July; last update search June 2011). Nonpharmacological treatments for attention-deficit/hyperactivity disorder (ADHD): Neurofeedback. Retrieved October 31, 2011 from www.Hayesinc.com/subscribers. (33 articles and/or guidelines reviewed)

Winifred S. Hayes. Medical Technology Directory. (2008, March; last update search March 2011). Biofeedback therapy for vulvodynia. Retrieved April 28, 2010 from www.Hayesinc.com/subscribers. (30 articles and/or guidelines reviewed)

ORIGINAL EFFECTIVE DATE: 4/1980

MOST RECENT REVIEW DATE: 3/9/2012

ID_BA

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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