Archived Policies - Mental Health



Effective Date:09-23-2004

End Date:12-31-2005


FOR TEXAS (when not used to treat an acquired brain injury), ILLINOIS and NEW MEXICO:

Biofeedback therapy, utilizing electromyographic or skin temperature measurements, is considered medically necessary used for the treatment of the following diagnosed conditions:

  • Any pain syndrome, felt to be caused or exacerbated by an anxiety state,
  • Pain resulting from primary idiopathic Raynaud's disease,
  • Torticollis (spasmodic neck muscles),
  • Bruxism (may be associated with Temporomandibular Joint Syndrome),
  • Generalized and phobic anxiety (not panic disorder),
  • Headache, including but not limited to migraine, vascular, or tension, after appropriate diagnostic evaluation, and
  • Muscle reeducation of specific muscle groups or for treating pathological muscle abnormalities of spasticity, incapacitating muscle spasm or weakness, such as myofacials syndromes, including but not limited to muscle pain of the low back, neck, and shoulder area, and used frequently with a medically necessary physical medicine program.

Biofeedback therapy is considered investigational for:

  • Relaxation methods for the treatment of diabetes,
  • Side effects of Chemotherapy treatment,
  • Relaxation methods for prenatal instruction in preparation of labor and delivery,
  • Any methods/applications for the treatment of Attention Deficit Disorder,
  • Regulation of blood pressure for essential hypertension,
  • Conduction disorder for arrhythmias,
  • Electro-oculogram application for blepharospasm,
  • Anorectal methods/applications, including those by electromyogram and/or manometry, for anorectal incontinence,
  • Pelvic floor muscle exercises/training for urinary incontinence, and
  • Any other unlisted methods/applications for any conditions not previously listed.

Special Comment on Management of Biofeedback Therapy:

Biofeedback therapy should be:

  • Followed by a psychological assessment when appropriate;
  • Provided by a trained technician under the supervision of a physician or Ph.D. psychologist with training and/or experience in biofeedback;
  • Permitted for a maximum of 30 sessions per any one symptom complex; and,
  • Allowed for a maximum of twice daily for an inpatient setting or once daily for an outpatient setting.


Biofeedback is training procedures aimed at helping a patient achieve control over a physiologic process/function.  Biofeedback therapy provides the patient with visual, auditory, or other signals from a monitoring device allowing the patient to voluntarily exert control over the targeted body function.  The functions are transformed into a tone or light, the loudness or brightness of which shows the extent of activity.  The functions monitored are:

  • Heart rate
  • Peripheral vasomotor activity
  • Skin temperature
  • Salivation
  • Blood pressure
  • Gross muscle tone

Biofeedback therapy differs from electromyography; a diagnostic procedure used to record and studies the electrical properties of skeletal muscles.  An electromyography device may be used to provide biofeedback information to the patient.

There have been numerous controlled studies demonstrating some degree of clinical effectiveness of biofeedback in a wide spectrum of clinical problems.


There are several methodologic difficulties in assessing biofeedback. For example, most interventions that include biofeedback are multimodal and include relaxation and behavioral instruction (which may have an independent effect). While studies may report a beneficial effect of multimodality treatment, without appropriate control conditions, it is impossible to isolate the specific contribution of biofeedback to the overall treatment effect. For example, relaxation, attention, or suggestion may account for the successful results that have been attributed to biofeedback.

Information on specific coverage allowance of biofeedback contained in this policy is mandated by the Texas Legislature for Texas contracts only.


Each benefit plan, summary plan description or contract defines which services are covered, which services are excluded, and which services are subject to dollar caps or other limitations, conditions or exclusions. Members and their providers have the responsibility for consulting the member's benefit plan, summary plan description or contract to determine if there are any exclusions or other benefit limitations applicable to this service or supply. If there is a discrepancy between a Medical Policy and a member's benefit plan, summary plan description or contract, the benefit plan, summary plan description or contract will govern.


When benefits are paid for biofeedback services for the diagnosis of an acquired brain injury, they should be paid as an illness, not as a psychiatric service.

Medicare Coverage:




Policy History:

Archived Document(s):

Title:Effective Date:End Date:
Biofeedback for Miscellaneous Indications07-01-201802-14-2019
Biofeedback for Miscellaneous Indications07-15-201706-30-2018
Biofeedback for Miscellaneous Indications04-01-201607-14-2017
Biofeedback for Miscellaneous Indications10-01-201503-31-2016
Biofeedback for Miscellaneous Indications12-01-201409-30-2015
Biofeedback for Miscellaneous Indications02-01-201311-30-2014
Biofeedback and Neurofeedback02-15-200901-31-2013
Biofeedback and Neurofeedback06-15-200702-14-2009
Biofeedback and Neurofeedback01-01-200606-14-2007
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