Biofeedback as a Treatment of Headache and other Disorders  Printer-Friendly Version
Medical Policy: 02.01.05
Original Effective Date: October 2002
Reviewed: January 2008
Revised: January 2008
This policy applies to all products unless specific contract
limitations, exclusions or exceptions apply. Please refer to the member's coverage
manual for benefit availability. Managed care guidelines related to referral authorization,
and precertification of inpatient hospitalization, home health, home infusion and
hospice services apply.
Description:
Biofeedback techniques are used in behavioral medicine for treating several medical conditions, including asthma, hypertension, muscle spasms and recurrent headaches. 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 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 minutes each.
The various forms of biofeedback differ mainly in the physiologic information that is fed back to the individual. 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.
The use of Neurofeedback as an investigational treatment for attention deficit hyperactivity disorder (ADHD) involves the use of electroencephalograph data to monitor and shape the frequency of brain activity to improve concentration. Other uses of biofeedback and Neurofeedback have also been investigated to treat a wide variety of organic and psychological problems.
Policy:
Biofeedback may be considered a medical necessity for headaches.
See the related policy number 02.01.04 Anorectal Biofeedback
Biofeedback is considered investigational and is not a covered benefit for any other diagnoses, or if it is excluded from the benefit certificate.
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Procedure Codes and Billing
Guidelines:
- To report provider services, use appropriate CPT* codes, Alpha Numeric (HCPCS level 2) codes, Revenue codes, and/or ICD-9 diagnostic codes
- CPT code 90901 Biofeedback training by any modality
- CPT code 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
- CPT code 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
- HCPCS code 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.
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New information or technology that would be relevant for Wellmark to consider when this policy is next reviewed may be submitted to:
Wellmark Blue Cross and Blue Shield
Medical Policy Analyst
Station 304
636 Grand Ave
Des Moines, Iowa 50309
*Current Procedural Terminology © 2008 American Medical Association. All Rights Reserved.
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