Some medical and psychological insurance plans now cover neurofeedback and/or biofeedback for various conditions. Reimbursement to the client varies by carrier and by plan. Check with your insurance company about coverage for biofeedback. Neurofeedback is a form of biofeedback, and is billed as biofeedback.
- Be sure you understand what your insurance policy will cover, and for which diagnoses.
- Important: If you are told that biofeedback is covered, be certain to document the name of the insurance representative, with whom you spoke, the date and time of your conversation. This information will be needed in the event of any misunderstandings regarding coverage or any reimbursement refusals by your insurance carrier. We have experienced instances when a representative had assured a client that biofeedback would be covered, but later the insurance company refused to reimburse the client. If you have documented your conversation, you are more likely to win an appeal.
You may ask your insurance carrier about coverage for specific CPT (Current Procedure Terminology) codes. We use the following codes:
INITIAL CONSULTATION: 90837 or 90832
Some insurance companies reimburse one code preferentially. This code is used for counseling sessions as well.
QEEG (BRAIN MAP): 95816, 95957, and 96132
95816 refers to the qEEG recording, 95957 refers to the digital analysis of the recording (eliminating artifact and comparing to the database), and 96132 refers to the evaluation of the recording and accompanying report by a neurologist.
IVA+PLUS CONTINUOUS PERFORMANCE TEST: 96146
This is a computerized test of focus and attention.
INTAKE INTERVIEW: 90791
This session includes an in-depth verbal review of the qEEG results and treatment planning.
BIOFEEDBACK AND NEUROFEEDBACK: 90901 or 96158 &96159
- 90901 is used for psychological disorders, such as: Anxiety, Depression, Post Traumatic Stress Disorder and Attention Deficit Disorder
- 96158 & 96159 Health/ Behavioral Intervention, is used only for medical diagnoses such as:
- F51.01 – Primary Insomnia
- G44.209 – Tension Type Headache
- G43.911 – Migraine
- F07.81 – Post Concussion Syndrome
- G44.329 – Chronic post traumatic headache
- S06.0X0A – Concussion w/o loss of consciousness
- I73.00 – Raynaud’s
- K59.00 – Constipation
- H93.1 -Tinnitus
- K58.9 – Irritable Bowel Syndrome
Other questions you might ask your health insurance company:
Is biofeedback a covered benefit under my insurance policy? _______
– If the answer is yes, then:
- Is it covered under a. Medical Services? ____ b. Psychological Services? ____
- For which diagnosis is it covered? __________
- Under which code is it covered? a. 90901 ____ b. 96152 ____
- Do I need a prescription or letter from my medical doctor to say that it is medically necessary?
- Do I need a referral from my primary care physician? ____
- Will I need preauthorization? _____ If so, what is the preauthorization code? ____
- How many sessions are allowed? ____ a. Per week? ____ b. Per year?____ c. Is there a dollar amount limit? ____
- Is there a deductible? a. If so, what is it? ____ b. If so, how much of the deductible has been met? ______
- Is there a co pay? _______ If so, what is it? _____
- If biofeedback is covered, can counseling (90837, 90834 or 90832) be billed on the same day?
- Is there a limit to the total amount the insurance company will reimburse each year? Is there an annual benefits cap that could affect the amount of my reimbursement?