Is Bio/Neurofeedback Covered by Insurance? What You Need to Know

Coverage for biofeedback and neurofeedback varies widely depending on your insurance plan, provider, and the specific condition being treated. While some insurance policies do offer coverage for these therapies, others may label them as experimental or alternative, making reimbursement more difficult.

Let’s explore the details so you can better understand what to expect when it comes to getting these therapies covered by insurance.

Coverage Basics

Insurance coverage for biofeedback and neurofeedback can be a bit of a maze.

Here’s what you need to know upfront:

Criteria	Details
Varies by Insurance Carrier and Plan	Coverage can differ greatly between insurance providers. Larger, more comprehensive plans may cover biofeedback and neurofeedback, while others might not.
Diagnosis Matters	Coverage often depends on the specific condition. For instance, biofeedback may be covered for chronic pain or migraines but not for general wellness. Neurofeedback may be covered for ADHD but not for anxiety.
Pre-authorization May Be Required	Coverage may require pre-authorization, meaning approval from your insurance provider before starting treatment. This typically involves a referral from your doctor.
CPT Codes	Specific CPT codes are used to bill for biofeedback and neurofeedback. For example, CPT code 90901 is for biofeedback training. Knowing these codes can help clarify coverage details with your insurer.

How to Determine Coverage

1. Contact Your Insurance Company

Call the number on the back of your insurance card. Explain that you are seeking information about biofeedback or neurofeedback coverage. Ask directly if your plan covers these therapies. Make sure to specify the condition being treated, as this will often influence the answer.

According to Aspiring Families, thanks to FDA approval, some insurance companies are now providing reimbursement for neurofeedback sessions.

2. Verify CPT Codes

Ask if the following CPT codes are covered:

90901: Biofeedback training by any modality.
90875 and 90876: Biofeedback combined with psychotherapy.

Verify if any pre-authorization is required and under what conditions.

3. Get It in Writing

Request written confirmation of the coverage details discussed. This could be in the form of an email, a policy document, or even detailed notes from your conversation with the insurance representative.

Documentation Is Key

Insurance coverage documentation infographic

Accurate documentation can be your best friend in case of a dispute. Here’s what to note:

Name of the Representative: Always ask for the name of the insurance representative you speak with.
Date and Time of Call: Log the date and time of each conversation.
Summary of the Conversation: Write down key points discussed, especially any details about coverage, pre-authorizations, or required documentation.
Reference Numbers: Ask for a reference number for the call, which can be crucial for tracking.

Keeping a detailed record of all your interactions with the insurance company helps protect you if there’s a disagreement about what was covered.

What If You’re Denied Coverage?

It’s not uncommon for initial claims to be denied. Here’s what you can do:

Request an Explanation

Understand the reason for denial. It might be due to missing documentation, incorrect coding, or the therapy being labeled as experimental.

File an Appeal

Use the information you’ve documented to support your case. Include all records of communication, medical necessity documentation from your healthcare provider, and any supporting research that backs up the effectiveness of the treatment for your condition.

Get Support

If the process feels overwhelming, consider seeking help from a healthcare advocate or your healthcare provider’s billing department. They often have experience navigating the appeals process.

Alternative Payment Options

If your insurance won’t cover biofeedback or neurofeedback, there are still ways to make it more affordable:

Health Savings Accounts (HSAs) or Flexible Spending Accounts (FSAs)

If you have an HSA or FSA, you might be able to use these funds to pay for biofeedback or neurofeedback sessions. Check with your account provider to confirm eligibility.

Sliding Scale Fees

Some practitioners offer sliding scale fees based on your income or financial situation.

Clinical Trials or Research Studies

Occasionally, you may find research studies or clinical trials offering these therapies at a reduced cost or even for free.

Why Is Coverage So Varied?

Insurance companies often base coverage decisions on whether a treatment is deemed “medically necessary” and supported by sufficient scientific evidence. Unfortunately, biofeedback and neurofeedback fall into a gray area for many insurers. While there is growing evidence supporting their use for certain conditions, some insurers remain cautious, classifying them as alternative or experimental therapies.

Conditions More Likely to Be Covered

Certain conditions are more likely to receive coverage for biofeedback and neurofeedback treatments. These may include:

ADHD: Neurofeedback has shown promising results in managing ADHD symptoms, and some insurers may cover it when traditional treatments have not been effective.
Chronic Pain: Biofeedback is often covered for chronic pain management, especially if it’s used as part of a broader pain management program.
Migraine and Tension Headaches: Biofeedback has been found effective in reducing the frequency and severity of headaches, making it a potentially covered treatment.

Final Thoughts

The key to securing insurance coverage for biofeedback or neurofeedback is persistence, clear communication, and thorough documentation. Make sure to ask your insurance provider detailed questions about coverage, confirm which conditions and CPT codes are eligible, and document every conversation.