UPDATE: CPT Codes for Billing Insurance

[Rob Longo]

List mates:

 

As you know, ISNR has been working with the AMA to establish defined CPT codes for neurofeedback.  We will keep you posted as we proceed.  In addition, we will be sending out occasional reminders regarding donations to help ISNR work with the AMA to process these codes. You can make a donation here:  https://isnr.org/cpt-initiative-donation

 

Below and attached is the updated information for billing insurance for Neurofeedback sessions:

 

Neurofeedback Billing and Coding

 

Notes taken from https://www.youtube.com/watch?v=sLJyKKlGP8g

 

CPT Codes: What we have

Treatment codes:

1. 90901 - Biofeedback by any modality - untimed code

1. 90875/90876 - Psychophysiological therapy (behavioral)
1. Psychotherapy + Biofeedback - timed codes, can only be provided by mental health providers.  Can not bill as just a psychotherapy code because there are more specific codes.

qEEG:

1. 96020 - Neurofunctional testing selection and administration during noninvasive imaging functional brain mapping, with test administered entirely by a physician or other qualified health care professional (ie psychologist), with review of test results and report. This is typically only billable by psychiatrist or PhD psychologists.  This is to confirm or disconfirm a diagnosis, NOT to just plan neurofeedback.

1. 95816, 95819 or 95954 plus code 95957 - these are various EEG codes.  95957 is for a quantitative analysis.  This is for localization of visual abnormalities, not normative database comparison or treatment planning (cannot be billed with 96020 because this is included already). 

 

CPT Codes: Common Questions

• Can I bill a psychotherapy and 90901 as separate procedures on the same day?
• Yes.  To meet this requirement you need to use a modifier on the end of 90901 or the process of the private insurer.  Submit the codes even if they are being rejected!  This helps build evidence that these codes should be included going forward.
• Medicare you use an ABN and appropriate modifier
• You must also make sure each procedure has its own notation in your documents with specific start and end times and goals.  Modifiers GA, GX, GY, and GZ.  You need to charge the patient for BOTH procedures and have this clearly documented to justify this being billed as a separate procedure, with separate encounter and progress notes.
• Do I have to use FDA cleared/registered equipment?
• Yes, the FDA has determined they regulate biofeedback and neurofeedback and when they do it is necessary to use FDA authorized equipment when using the appropriate CPT codes.  If you are not a licensed practitioner treating a diagnosed condition, then you can use any non-FDA authorized biofeedback equipment.
• Does this service have to be administered one-to-one and face-to-face?
• Yes.  It can also be applied with incident-to billing, but the licensed provider must be physically in the office suite where the service is being provided and initiated the service (treatment plan must be created by a licensed provider, who’s scope incudes supervision of appropriately trained and qualitfied technicians).

 

Billing Insurance: Reimbursement

Must look at the specific insurance contract to make sure billing codes are not EXCLUDED, such as seen in BCBS Federal.  If they are, you can you have to bill a 90832 or 90834 with a the ABN process and bill a 90901 and charge the patient something as a separate charge.

• BCBS local plans covering in 9+ states, but not always for all diagnoses (sometimes only ADHD for children is covered).
• Cigna and United have covered, but only on a specific case-by-case eval through their internal appeals process.
• Employers can set their own contracts, so need to check specifically the contract.
• Mental health parity may be used to advocate for coverage.

Denials, excluded services, appeals, and advocacy

• Medical Necessity - Burden of proof is on the provider
• You must show that this is not experimental and should be covered under mental health parity in states that are in ACA
• Treatment limitations – for example: may only cover 12 sessions and start to deny, they set the limit and may not mention it anywhere
• Fail first policies – for example: TMS has a fail first policy with most insurances requiring a person to fail 2 depression meds before they qualify for TMS to be covered by insurance.
• These can all be challenged by providers.  Insurance companies must provide their rules behind it and they have to apply it across medical and mental health.

 

• Mental Health Parity
• Physical and Mental Health must have equal rules and they must be applied equally
• Provider can ask for this information if you are considering a contract or appealing a denial
• Burden of proof is on the insurance company to prove it is equivalent
• If they are not offering you a contract, you can appeal on MH parity by asking if their network is actually sufficient, eg Neurofeedback for ADHD, brain injury, and substance abuse.  IF not covered by insurance, this could be Mental Health Parity abuse.
• Materials exist to help wtih appeals
• NFB parity site from Applied Neuroscience
• Templates for various stages for ADHD both in and out of network, tracking excel file (slightly out of date at this time)
• Kennedy forum for MH Parity
• Provided technology assessment stating that NFB is evidence for ADHD, TBI, and SA
• Materials for requesting Parity information and making appeals
• Provide links to state agencies to enforce MH Parity

END

 

Be Well, Stay Safe

 

Rob

 

Robert E. Longo, MRC, LCMHC, NCC, BCN

ISNR Board Member

FNNR Advisory Board Member

 

Rob’s Publications from FNNR:  

Soutar & Longo (Forthcoming) Functional Neurofeedback. An Overview.  Greenville, SC: FNNR.   

Longo, R.E. & Bingham, B (2022). Beginning neurofeedback in your practice: A guide for clinicians using neurofeedback from intake to discharge. Greenville, SC: FNNR.

Longo, R.E. & Soutar, R. (2019). Becoming Certified in Neurofeedback.   Greenville, SC: FNNR.

Longo, R.E.  (2018).  A consumer’s guide to understanding QEEG brain mapping and neurofeedback training.  Greenville, SC: FNNR.

Soutar, R. & Longo, R.E. (2022). Doing Neurofeedback.: An Introduction (2nd Edition).  Greenville, SC: FNNR.

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[Peggy Hill]

Rob, no Hawaii medical insurance company will cover those codes. Neurofeedback is an acceptable practice only when performed as part of a larger mental health treatment. No stand alone. 

Peggy Hill, LCSW, QEEGD, BCN, Sr. Fellow

Learn about neurofeedback & Ho’o mana’o Kakou ou kou

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[Rob Longo]

Peggy:

 

Every state is different.  I always encourage clinicians to discuss proper code use with each insurance company.  For example, one insurance company may cover NFB in one state but not another. 

 

These codes are the proper one to use when your state accepts insurance coverage for NFB services.

To view this discussion visit https://groups.google.com/d/msgid/isnr_members_forum/CADCWeLr3ymyk5s78jiPgBZE-Yg307npgrgaT9jYAetrCtLQS-A%40mail.gmail.com.

[lrob...@gmail.com]

(This was sent out on March 14^th 2025.  I am resending again so there is clarity about CPT Codes and billing).

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