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Coverage criteria policies

Biofeedback for behavioral health applications

These services may or may not be covered by your HealthPartners plans. Please see your plan documents for your specific coverage information. If there is a difference between this general information and your plan documents, your plan will be used to determine your coverage.

Administrative Process

Prior authorization is not required for biofeedback for behavioral health applications.

Coverage

Biofeedback for behavioral health applications is generally not covered unless it is part of a behavioral health treatment plan.

Indications that are covered

Biofeedback is only covered when it is part of a behavioral health treatment plan for diagnoses other than those listed in the Indications not covered section.

Indications that are not covered

Biofeedback is not covered for conditions for which there is no scientific evidence supporting its effectiveness. These conditions include, but are not limited to:

  1. Schizophrenia
  2. Schizoaffective disorders
  3. Adjustment disorders
  4. Depression
  5. ADHD (attention deficit hyperactivity disorder)
  6. Addictions

Definitions

Biofeedback therapy provides visual, auditory or other evidence of the status of certain body functions so that a person can exert voluntary control over the functions, and thereby alleviate an abnormal bodily condition.

Biofeedback therapy often uses electrical devices to transform bodily signals indicative of such functions as heart rate, blood pressure, skin temperature, salivation, peripheral vasomotor activity, and gross muscle tone into a tone or light, the loudness or brightness of which shows the extent of activity in the function being measured.

If available, codes are listed below for informational purposes only, and do not guarantee member coverage or provider reimbursement. The list may not be all-inclusive.

Codes

Description

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); 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); 45 minutes

CPT Copyright American Medical Association. All rights reserved.  CPT is a registered trademark of the American Medical Association.

Products

This information is for most, but not all, HealthPartners plans. Please read your plan documents to see if your plan has limits or will not cover some items. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage. These coverage criteria may not apply to Medicare Products if Medicare requires different coverage. For more information regarding Medicare coverage criteria or for a copy of a Medicare coverage policy, contact Member Services at 952-883-7979 or 1-800-233-9645.

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Policy activity

  • 08/12/2003 - Date of origin
  • 10/01/2016 - Effective date
Review date
  • 10/2017

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