Anthem Blue Cross Blue Shield of California policy
CG-MED-97 Biofeedback and Neurofeedback
CG-MED-97 Biofeedback and Neurofeedback is a public Anthem Blue Cross Blue Shield of California policy (policy CG-MED-97). It lists 7 CPT or HCPCS codes, 7 of them on the Anthem Blue Cross Blue Shield of California prior authorization list. Not a coverage decision; the payer's own document governs.
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- 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 Blue Shield of California prior authorization list.
| Code | Prior authorization | Description on the prior authorization list | Other Anthem Blue Cross Blue Shield of California policies |
|---|---|---|---|
| 90875 | On the list | Individual psychophysiological therapy incorporating biofeedback training by any modality (face-to-face with the patient), with psychotherapy (e.g., insight oriented, behavior modifying or supportive psychotherapy); 30 minutes or [when specified as EEG biofeedback or neurofeedback] | Policies naming 90875 |
| 90876 | On the list | Individual psychophysiological therapy incorporating biofeedback training by any modality (face-to-face with the patient), with psychotherapy (e.g., insight oriented, behavior modifying or supportive psychotherapy); 45 minutes or [when specified as EEG biofeedback or neurofeedback] | Policies naming 90876 |
| 90901 | On the list | Biofeedback training by any modality or [when specified as EEG biofeedback or neurofeedback] | 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 qualified health care professional contact with the patient | 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 other qualified health care professional contact with the patient | Policies naming 90913 |
| E0746 | On the list | Electromyography (EMG), biofeedback device [when specified as a home biofeedback device other than the SPEAC sEMG activity alert system for seizures which is addressed elsewhere] or [when specified as the SPEAC system] | Policies naming E0746 |
| S9002 | On the list | Intra-vaginal motion sensor system, provides biofeedback for pelvic floor muscle rehabilitation device | Policies naming S9002 |
All Anthem Blue Cross Blue Shield of California policies · Anthem Blue Cross Blue Shield of California prior authorization CPT list