Anthem Blue Cross and Blue Shield Virginia policy
CG-MED-97 Biofeedback and Neurofeedback
CG-MED-97 Biofeedback and Neurofeedback is a public Anthem Blue Cross and Blue Shield Virginia policy (policy CG-MED-97). It lists 7 CPT or HCPCS codes, 7 of them on the Anthem Blue Cross and Blue Shield Virginia prior authorization list. Not a coverage decision; the payer's own document governs.
- Policy number
- CG-MED-97
- Line of business
- Commercial
- Source
- www.anthem.com
Codes in this policy
The CPT and HCPCS codes the policy names. A policy can name a code it excludes. Prior authorization status is from the Anthem Blue Cross and Blue Shield Virginia prior authorization list.
| Code | Prior authorization | Description on the prior authorization list | Other Anthem Blue Cross and Blue Shield Virginia policies |
|---|---|---|---|
| 90875 | On the list | Individual psychophysiological therapy incorporating biofeedback training by any modality (face-to-face with the patient), with psychotherapy (eg, insight oriented, behavior m | Policies naming 90875 |
| 90876 | On the list | Individual psychophysiological therapy incorporating biofeedback training by any modality (face-to-face with the patient), with psychotherapy (eg, insight oriented, behavior m | Policies naming 90876 |
| 90901 | On the list | Biofeedback Training, Any Modality | Policies naming 90901 |
| 90912 | On the list | Biofeedback training, perineal muscles, anorectal or urethral sphincter, including EMG and/or manometry, when performed; initial 15 minutes of one-on-one physician or other qu | Policies naming 90912 |
| 90913 | On the list | Biofeedback training, perineal muscles, anorectal or urethral sphincter, including EMG and/or manometry, when performed; each additional 15 minutes of one-on-one physician or | Policies naming 90913 |
| E0746 | On the list | Electromyograph Biofeedback | Policies naming E0746 |
| S9002 | On the list | Intravaginal motion sensor system, provides biofeedback for pelvic floor muscle rehabilitation device | Policies naming S9002 |
All Anthem Blue Cross and Blue Shield Virginia policies · Anthem Blue Cross and Blue Shield Virginia prior authorization CPT list