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Medical Policy: 02.01.05
Original Effective Date: October 2002
Reviewed: December 2011
Revised: December 2011
Benefit Application
Benefit determinations are based on the applicable contract language in effect at the time the
services were rendered. Exclusions, limitations or exceptions may apply. Benefits may vary
based on contract, and individual member benefits must be verified. Wellmark determines medical
necessity only if the benefit exists and no contract exclusions are applicable. This medical
policy may not apply to FEP. Benefits are determined by the Federal Employee Program.
This Medical Policy document describes the status of medical technology at the time the document
was developed. Since that time, new technology may have emerged or new medical literature may
have been published. This Medical Policy will be reviewed regularly and be updated as scientific
and medical literature becomes available.
Description:
Biofeedback is a technique intended to teach patients self-regulation of certain physiologic processes not normally considered to be under voluntary control. It is frequently used in conjunction with other therapies (i.e., relaxation, behavioral management, medication) to reduce the severity and/or frequency of headaches and as a treatment for a variety of diseases and disorders including anxiety, hypertension, movement disorders, incontinence, pain, and asthma. Professionals who use this technique assume that patients who achieve greater biofeedback control over the relevant physiological functions will be more successful in reducing their symptoms.
Biofeedback involves the feedback of a variety of types of information not normally available to the patient, followed by a concerted effort on the part of the patient to use this feedback to help alter the physiological process in some specific way. Biofeedback training is done either in individual or group sessions, alone or in combination with other behavioral therapies designed to teach relaxation. A typical course of treatment consists of 10 to 20 training sessions of 30 to 60 minutes each. Training sessions are conducted in a quiet, non-rousing environment. Subjects are instructed to use mental techniques to affect the physiologic variable monitored, and feedback is provided for successful alteration of the physiologic parameter. This feedback may be signals such as lights or tone, verbal praise, or other auditory or visual stimuli.
The various forms of biofeedback differ mainly in the nature of the disease or disorder under treatment, the biologic variable that the individual attempts to control, and the information that is fed back to the individual. Biofeedback techniques include peripheral skin temperature feedback, blood-volume-pulse feedback (vasoconstriction and dilation), vasoconstriction training (temporalis artery), and electromyographic (EMG) biofeedback; these may be used alone or in conjunction with other therapies. Generally, EMG biofeedback is used to treat tension headaches, and thermal biofeedback is used to treat migraine headaches. In EMG biofeedback, electrodes are attached to the temporal muscles. The degree of muscle tension is fed back to the individual being treated and the subject is asked to reduce muscle tension. For thermal biofeedback, a temperature sensor is placed on the finger, and the subject is taught to increase the temperature, an effect that is mediated through peripheral vasodilation.
A variety of biofeedback devices are cleared for marketing through the U.S. Food and Drug Administration (FDA) 510(k) process. These devices are designated by the FDA as class II with special controls and are exempt from the premarket notification requirements. The FDA defines a biofeedback device as “an instrument that provides a visual or auditory signal corresponding to the status of one or more of a patient’s physiological parameters (e.g., brain alpha wave activity, muscle activity, skin temperature, etc.) so that the patient can control voluntarily these physiological parameters.”
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Prior Approval:
Not applicable
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Policy:
Biofeedback may be considered medically necessary as part of the overall treatment plan for migraine and tension-type headache.
Biofeedback for the treatment of cluster headache is considered investigational.
Unsupervised home use of biofeedback for treatment of headache is considered not medically necessary.
Biofeedback is considered investigational for all indications not listed above including, but not limited to:
- Asthma
- Anxiety disorders
- Insomnia
- Sleep bruxism
- Tinnitus
- Movement disorders
- Bell’s palsy
- Motor function after stroke, injury, or lower-limb surgery
- Raynaud’s disease or phenomenon
- Orthostatic hypotension in patients with spinal cord injury
- Hypertension
- Autism
There continues to be insufficient evidence to demonstrate the effectiveness of biofeedback for the miscellaneous conditions listed above. Studies either fail to demonstrate any beneficial impact of biofeedback or had design flaws that leave the durability of effects in question or create uncertainty about the contribution of nonspecific factors such as attention or placebo effects.
See the related policy number 02.01.04 Anorectal Biofeedback
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Procedure Codes and Billing Guidelines:
- To report provider services, use appropriate CPT* codes, Modifiers, Alpha Numeric (HCPCS level 2) codes, Revenue codes, and/or ICD-9 diagnostic codes
- 90901 Biofeedback training by any modality
- 90875 Individual psychophysiological therapy incorporating biofeedback training by any modality (face-to-face with the patient), with psychotherapy (eg, insight oriented, behavior modifying or supportive psychotherapy); approximately 20-30 minutes
- 90876 Individual psychophysiological therapy incorporating biofeedback training by any modality (face-to-face with the patient), with psychotherapy (eg, insight oriented, behavior modifying or supportive psychotherapy); approximately 45-50 minutes
- E0746 Electromyography (EMG), biofeedback device
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Selected References:
- Sarafino EP, Goehring BA. Age comparisons in acquiring biofeedback control an success in reducing headache pain. Annals of Behavioral Medicine 2000; 22(1):10-16.
- Bussone G, Grazzi L, D’Amico D, Leone M, Andrasik F. Biofeedback-assisted relaxation training for young adolescents with tension-type headache: a controlled study. Cephalalgia 1998; 18: 463-467.
- Mauskop A. Alternative Therapies in Headache. Is there a role? Headache 2001; 85(4):1077-1084.
- Silberstein SD, Rosenberg J. Multispecialty consensus on diagnosis and treatment of headache. Neurology 2000;54:1553.
- Yucha CB. Problems inherent in assessing biofeedback efficacy studies. Appl psychophysiol Biofeedback. 2002 Mar; 27(1): 99-106.
- Nakao M, Yano E, Nomura S et al. Blood pressure-lowering effects of biofeedback treatment in hypertension: a meta-analysis of randomized controlled trials. Hypertens Res 2003; 26(1):37-46.
- Sierpina V, Astin J, Giordano J. Mind-Body Therapies for Headache. Am Fam Physician 2007;76:1518-1522.
- National Institute of Neurological Disorders and Stroke (NINDS). Headache information page. Available at: http://www.ninds.nih.gov/disorders/headache/headache.htm. Last viewed May 2009.
- Silkman C, McKeon J. The effectiveness of electromyographic biofeedback supplementation during knee rehabilitation after injury. J Sports Rehabil 2010; 19(3):343-51.
- Coben R, Myers TE. The relative efficacy of connectivity-guided and symptom-based EEG biofeedback for autistic disorders. Appl Psychophysiol Biofeedback 2010; 35(1):13-23.
- Mann JD, Coeytaux RR. Migraone and tension-type headache. In: Rakel D, ed. Integrative Medicine, 2nd edition. Philadelphia: Saunders Elsevier, 2007.
- Gerber WD, Petermann F, Gerber-von Muller G et al. MIPAS_Family-evaluation of a new multi-modal behavioral training program for pediatric headaches: clinical effects and the impact on quality of life. J Headache Pain 2010; 11(3): 215-25.
- Bendtsen L, Evers S, Linde M et al. EFNS guideline on the treatment of tensio-type headache-report of an EFNS task force. Eur J Neurol 2010; 17(11):1318-25.
- Nestoriuc Y, Martin A. Efficacy of biofeedback for migraine: a meta-analysis. Pain 2007; 128(1-2):111-27.
- Nestoriuc Y, Rief W, Martin A. Meta-analysis of biofeedback for tension-type headache: efficacy, specificity, and treatment moderators. J Consult Clin Psychol 2008; 76(3):279-96.
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Policy History:
Date Reason Action
December 2010 Annual review Policy renewed
December 2011 Annual review Policy renewed
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Wellmark medical policies address the complex issue
of technology assessment of new and emerging treatments, devices,
drugs, etc. They are developed to
assist in administering plan benefits and constitute neither offers of
coverage nor medical advice. Wellmark medical policies contain only a
partial, general description of plan or program benefits and do not
constitute a contract. Wellmark does not provide health care services
and, therefore, cannot guarantee any results or outcomes.
Participating providers are independent contractors in private
practice and are neither employees nor agents of Wellmark or its
affiliates. Treating providers are solely responsible for medical
advice and treatment of members. Our medical policies may be updated
and therefore are subject to change without notice.
*Current Procedural Terminology © 2010 American Medical Association. All Rights Reserved.
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