CurrentAmeriHealth CaritasPolicy CCP.1151

Biofeedback for chronic pain

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Defines coverage stance for biofeedback interventions for non-malignant musculoskeletal pain and primary headache disorders and member/provider requirements for coverage.

Policy Summary

PayerAmeriHealth Caritas

PolicyBiofeedback for chronic pain

Policy CodePolicy CCP.1151

Change TypeNo material change

Effective DateFeb 20, 2025

Last ReviewFeb 1, 2026

Next Review DateJun 1, 2027

Key ActionDocument patient motivation and ability to participate, the clinical indication, prior use and failure of conventional treatments when applicable, and ensure therapy is performed by a licensed clinician trained in biofeedback.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

90901, 90875, 90876, E0746Common related billing codes listed

3 indicationsExplicitly listed indications

insufficientEvidence strength for migraine alone

~1/3Meta-analysis proportion comparable to drugs

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CurrentAmeriHealth CaritasPolicy CCP.1151

Biofeedback for chronic pain

Customize your policy alerts

Sign up for AmeriHealth Caritas Policy CCP.1151 alerts

Get alerted when Policy CCP.1151 changes without checking for updates manually.

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Defines coverage stance for biofeedback interventions for non-malignant musculoskeletal pain and primary headache disorders and member/provider requirements for coverage.

Policy Summary

PayerAmeriHealth Caritas

PolicyBiofeedback for chronic pain

Policy CodePolicy CCP.1151

Change TypeNo material change

Effective DateFeb 20, 2025

Last ReviewFeb 1, 2026

Next Review DateJun 1, 2027

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

90901, 90875, 90876, E0746Common related billing codes listed

3 indicationsExplicitly listed indications

insufficientEvidence strength for migraine alone

~1/3Meta-analysis proportion comparable to drugs

16+Minimum age for migraine

Coverage Criteria for Biofeedback

Medically Necessary Indications

Covered when ALL of the following are met for the listed indications

Indication selection: Biofeedback is medically necessary for the following indications: (a) thermal or electromyography (EMG) biofeedback, alone or in combination with behavioral modalities, for treatment of migraine headache in members ages 16 years or older; (b) electromyography (EMG) biofeedback with or without relaxation therapy for treatment of tension-type headache in children, adolescents, and adults; (c) electromyography (EMG) biofeedback for treatment of chronic low back pain; (d) electromyography (EMG) biofeedback for muscle re-education of specific muscle groups or treatment of pathological muscle abnormalities (spasticity) or incapacitating muscle spasm or weakness, when more conventional treatments (e.g., heat, cold, massage, exercise, support) have not been successful.

Each branch above represents a distinct covered indication per the policy.

Member and Provider Eligibility Criteria

Coverage requires ALL of the following member/provider criteria

Member/provider requirements: Member must: demonstrate motivation to actively participate in the treatment plan (including practice and follow-through at home); be physically and cognitively capable of participating; have a condition appropriate for biofeedback (no pathology that would prevent success). Provider requirement: the biofeedback therapy must be performed by a licensed health care professional with training in biofeedback.

These criteria are required for coverage of the medically necessary indications listed.

All other uses of biofeedback that are not specifically listed as medically necessary in this policy are considered investigational/not medically necessary. Examples include indications outside the covered categories of migraine, tension-type headache, chronic low back pain, and specified neuromuscular re-education; these uses may be denied as not clinically proven.

No additional explicit exclusions are specified in the cited policy text. Providers should follow the listed covered indications and related criteria when determining medical necessity and consult the policy for permitted uses.

Electroencephalography biofeedback (neurofeedback) currently has insufficient evidence to support its routine use for chronic pain conditions and is regarded as investigational. Systematic reviews report limited, low-quality, and heterogeneous studies with modest or short-term effects at best, and higher-quality research is needed before neurofeedback can be considered medically necessary for general chronic pain indications.

Within the provided document excerpts there are no explicit statements labeled as not medically necessary beyond the investigational language for non-covered uses and for neurofeedback; decisions should be guided by the policy’s listed medically necessary indications and the investigational limitation for other uses.

Prior Conservative Treatment Requirements

Documentation of prior failure of conventional treatments should be available.

Conservative-treatment documentation: For electromyography biofeedback when used for muscle re-education or treatment of pathological spasticity/incapacitating muscle spasm or weakness, documentation should show that more conventional treatments (e.g., heat, cold, massage, exercise, support) have been attempted and were not successful.

Documentation should be available for review and may be requested during authorization or claims review.

Conservative treatment requirements — additional criteria and related nodes

Additional conservative treatment requirements and related considerations

Conservative treatment context: Where applicable, biofeedback is considered after or alongside alternative/adjunct conservative services such as physician management, pharmacotherapy, physical therapy, and behavioral health treatments; no specific mandatory trial durations are specified in the policy references.

Related Billing Codes

Related Codes (commonly submitted)mixed

90901	Biofeedback training, any method
90875	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).
90876	Individual psychophysiological therapy incorporating biofeedback training by any modality; face-to-face with the patient, without psychotherapy.
E0746	Electromyograph, biofeedback device

Provider Actions and Documentation Requirements

Prior Authorization

Member and provider eligibility — all criteria required

Coverage is limited to members who meet ALL of the following: demonstrate motivation to actively participate and follow the care plan; are physically and cognitively capable of participating; have a condition that can be appropriately treated with biofeedback (no pathology preventing success); and receive therapy performed by a licensed health care professional with training in biofeedback. Documentation of these eligibility elements should be available for review; prior authorization may be required per plan rules.

Motivation and adherence (e.g., practice/home follow-through)
Physical and cognitive capability to participate
Clinical condition appropriate for biofeedback (no prohibitive pathology)
Therapy performed by a licensed health care professional with training in biofeedback

Prior Authorization

Codes commonly submitted — follow plan prior-authorization rules

The policy lists commonly submitted procedure and device codes for biofeedback services but does not specify an explicit universal prior-authorization rule in the text; providers should follow plan-specific prior authorization procedures when applicable and submit the listed codes when requesting coverage.

Definitions

Biofeedback

DefinitionTherapy using visual, auditory, or other feedback signals from physiologic monitoring (e.g., EMG, skin temperature, heart rate, EEG) to teach patients to modulate involuntary or voluntary physiologic functions to alleviate symptoms.

PurposeTeach patients to actively change normally involuntary physiologic functions by providing perceptible feedback (visual or acoustic) so the function can be consciously modified.

Monitoring modalitiesCommon physiologic signals monitored include skin temperature, skin conductance/galvanic skin response, electromyography (muscle tension), electrocardiography (heart rate), and electroencephalography (brain wave activity).

Provider qualificationsServices must be delivered consistent with applicable state law, scope-of-practice rules, and facility credentialing; therapists are often licensed in another healthcare field and practice according to those guidelines.

Electromyography (EMG) biofeedback

Background and Evidence Summary

Biofeedback is a biobehavioral technique that uses physiologic monitoring—such as electromyography (EMG), thermal sensors, heart rate/ECG, or electroencephalography (EEG)—combined with visual or auditory feedback to teach patients voluntary control over physiological processes. It is used as an adjunctive therapy for headache disorders, chronic pain conditions, and neuromuscular re-education; the evidence base and recommended modalities vary by indication.

Frequency and Limits

Frequency limits

Frequency limitsNo specific frequency limits are specified in the policy for biofeedback services.

Documentation expectationProviders should document clinical necessity and adherence to any plan-specific authorization or management rules when frequency is reviewed.

Coding noteWhen frequency is adjudicated, claims must use appropriate codes (e.g., 90901, 90875, 90876, E0746) as listed by the policy.

Imaging Requirements

Note

Imaging not required by policy

No specific imaging requirements are specified in the policy sections cited.

If imaging is relevant to clinical care, document rationale; the policy does not mandate imaging prior to biofeedback.

Not Covered / Investigational Uses

Uses of biofeedback for indications not listed as medically necessary—particularly many chronic musculoskeletal pain conditions such as temporomandibular disorders, chronic neck pain, shoulder pain, patellofemoral pain, knee osteoarthritis, and fibromyalgia—have limited or inconclusive evidence and are considered not covered per the policy’s investigational determination.

Systematic reviews for these conditions generally report very low study quality, heterogeneity of protocols, and lack of long-term follow-up, leading to inconclusive findings; therefore these indications are not supported as medically necessary in the current policy.

The evidence for biofeedback as a standalone or adjunctive treatment in many chronic musculoskeletal and other non-listed pain conditions remains limited. Systematic reviews examining temporomandibular disorders, chronic pelvic pain, irritable bowel syndrome, sickle cell disease, spinal cord injury, and other conditions show low-quality and heterogeneous studies; these findings support the policy position that such uses are not covered outside the specified medically necessary indications.

Where the literature is inconclusive or conflicting, the policy classifies those applications as investigational and not medically necessary until higher-quality evidence demonstrates clinical benefit.

In the provided excerpts no single procedural technique or specific indication is explicitly named as permanently excluded beyond the general investigational stance for non-covered indications. Providers should reference the policy’s listed medically necessary indications and the investigational language when assessing coverage.

Policy Summary

PayerAmeriHealth Caritas

PolicyBiofeedback for chronic pain

Policy CodePolicy CCP.1151

Change TypeNo material change

Effective DateFeb 20, 2025

Last ReviewFeb 1, 2026

Next Review DateJun 1, 2027

SourceLink

On This Page

Clinical judgment should guide sequencing; documentation of prior conservative management is requested when relevant to the indication (see muscle re-education criteria).

Modality-specific considerations

Migraine: Thermal or EMG biofeedback (alone or with behavioral modalities) is the covered modality for migraine in members age 16+.age >= 16 years
Per policy, migraine coverage is limited to members 16 years and older.
Tension-type headache: EMG biofeedback with or without relaxation therapy is the covered modality for tension-type headache across pediatric and adult ages.
Policy states coverage for children, adolescents, and adults.
Chronic low back pain: EMG biofeedback is the covered modality for chronic low back pain; consider concurrent conservative therapies as appropriate.
Refer to guideline evidence summaries when integrating with other treatments.

Exclusions and investigational modalities: Electroencephalography (EEG) neurofeedback is not supported by sufficient evidence for general chronic pain indications and is considered investigational/insufficiently supported for chronic pain per the policy references.

Uses of biofeedback outside the listed medically necessary indications are considered investigational and may be denied.

Commonly submitted codes: 90901, 90875, 90876, E0746
Providers should follow plan rules for prior authorization and supply clinical documentation as requested

Step Therapy

Consider alternative or adjunct covered services

Before or alongside biofeedback, the plan expects consideration of alternative or adjunct covered services such as physician office visits, pharmacotherapy, physical therapy, and behavioral health treatments as appropriate to the clinical situation.

Physician office visits
Pharmacotherapy
Physical therapy
Behavioral health treatments

Note

Provider qualifications and indication verification

Ensure therapy is delivered by a licensed health care professional with training in biofeedback and that clinical indication and patient factors meet the policy’s covered indications; maintain readiness to provide documentation of qualifications and indication on request.

Confirm provider licensure and training in biofeedback per applicable state law and facility credentialing
Verify the patient's indication aligns with one of the medically necessary conditions listed in the policy

Documentation Required

Required clinical documentation for coverage review

Document patient motivation and ability to participate, the clinical indication appropriate for biofeedback, and prior use and failure of more conservative therapies when applicable; also document that therapy is performed by a licensed professional trained in biofeedback.

Evidence of patient motivation and adherence capability (e.g., intent to practice at home)
Clinical rationale linking the patient’s condition to a covered indication
Records of prior conservative treatments and reasons for failure when required (e.g., for muscle re-education/spasticity)

Billing Rule

Coding and billing — consult coding manuals and bill appropriately

Providers are expected to consult current coding manuals and bill using appropriate procedure and device codes; the policy lists commonly submitted codes for reference.

Commonly submitted codes: 90901, 90875, 90876, E0746
This list is not exhaustive — verify coding with applicable coding guidance

Denial Risk

Investigational uses (non-covered) — may be denied

All uses of biofeedback not explicitly listed as medically necessary in the policy are considered investigational or not clinically proven and are therefore not medically necessary; such uses may be denied.

Examples include indications outside migraine, tension-type headache, chronic low back pain, and specified neuromuscular re-education

Note

Coding-related denial risk — use correct procedure/device codes

Claims must be billed with the appropriate biofeedback procedure or device codes; incorrect or inappropriate coding for services outside the listed indications may result in claim denials or processing issues.

Use appropriate codes for the service provided (e.g., 90901, 90875, 90876, E0746)
Incorrect coding or billing for investigational indications increases risk of denial

DefinitionA biofeedback modality measuring muscle tension or movement using electromyography (EMG) to enable muscle re-education or reduction of abnormal muscle activity.

Clinical usesUsed for muscle re-education, treatment of pathological spasticity or incapacitating muscle spasm/weakness, and as an adjunct in some headache and low back pain indications when supported by evidence.

Device codingRelated device code listed: E0746 — Electromyograph, biofeedback device.

Neurofeedback (EEG biofeedback)

DefinitionUse of electroencephalography (EEG) monitoring and feedback to train brainwave patterns (neurofeedback).

Evidence stanceElectroencephalography biofeedback (neurofeedback) lacks sufficient evidence to support its use for chronic pain conditions and is considered investigational/insufficiently supported for general chronic pain indications.

ContextWhile EEG biofeedback is a described modality of biofeedback, systematic reviews and guideline summaries do not provide robust support for its effectiveness in chronic pain per the policy.

Related notesNeurofeedback is mentioned alongside other monitored signals (EEG) used in biofeedback but is distinguished by limited evidence for chronic pain applications.

Biofeedback training — coding

CPT 90901Biofeedback training, any method (listed as a commonly submitted code).

CPT 90875Individual psychophysiological therapy incorporating biofeedback training by any modality; face-to-face with the patient, with psychotherapy.

CPT 90876Individual psychophysiological therapy incorporating biofeedback training by any modality; face-to-face with the patient, without psychotherapy.

HCPCS E0746Electromyograph, biofeedback device (listed as a commonly submitted code).