RetiredCapital BluecrossPolicy MP 2.095

Quantitative electroencephalography as a diagnostic aid for attention deficit/hyperactivity disorder

This Capital BlueCross medical policy (MP 2.095) governs the use of quantitative electroencephalography–based assessment of the theta/beta ratio (e.g., NEBA system) as a diagnostic aid for attention-deficit/hyperactivity disorder (ADHD) and states the policy position and coding guidance for applicable products.

Policy Summary

PayerCapital Bluecross

PolicyQuantitative electroencephalography as a diagnostic aid for attention deficit/hyperactivity disorder

Policy CodePolicy MP 2.095

Change TypeRetirement

Effective Date05/01/2025

Next Review Date

Key ActionProviders should document that a clinician's completed clinical evaluation was performed and that the QEEG (NEBA) was used only as adjunctive support.

POLICY UPDATE CHANGES

Retirement review conducted 09/27/2024; policy marked for retirement effective 05/01/2025.

1Covered Indication Statements (investigational conclusions)

6Historic consensus/updates (years of documented updates 2014-2024)

Coverage Summary & Policy Position

Scope: This policy (MP 2.095) governs use of quantitative electroencephalography–based assessment of the theta/beta ratio (for example, the NEBA system) as a diagnostic aid for attention‑deficit/hyperactivity disorder (ADHD).

Status: RETIRED (retirement effective 05/01/2025; last review 2024-09-27).

Policy statement summary: Quantitative electroencephalographic assessment of the theta/beta ratio is considered investigational / not covered as a diagnostic aid for ADHD. The evidence is inconsistent regarding theta/beta ratio differences and insufficient to demonstrate improved health outcomes or benefits when used as a diagnostic adjunct.

Medical Necessity / Investigational Determination

Medically Necessary / Investigational Determination

Policy statement:

Quantitative electroencephalographic-based assessment of the theta/beta ratio is considered investigational as a diagnostic aid for attention deficit/hyperactivity disorder.
There is insufficient evidence to support a general conclusion concerning the health outcomes or benefits associated with this procedure.

Intended / FDA-indicated use (background, not coverage)

Regulatory/contextual statements:

FDA-cleared NEBA device indicated to measure theta/beta ratio at electrode CZ in patients 6 to 17 years of age to be used combined with a clinician's evaluation to aid in diagnosis of ADHD; device not intended as stand-alone diagnostic.

Provider Actions & Billing Guidance

Documentation Required

Use limited to clinician-evaluated cases

Document that a clinician completed the clinical evaluation and that the QEEG/NEBA assessment was used only as adjunctive support (not as a standalone test). Note the NEBA device is intended to be combined with a clinician's evaluation and to confirm or support a completed clinical assessment.

NEBA indicated for ages 6–17 and to be used combined with a clinician's evaluation per FDA labeling.

Billing Rule

Claims for QEEG for ADHD considered investigational

Claims for quantitative electroencephalography (QEEG) used as a diagnostic aid for ADHD are considered investigational and are listed as not covered; billing of the listed CPT/procedure codes may be denied per benefit terms.

95812
95813
95816
95819
95957
$8040

Background & Evidence Summary

Background: Quantitative EEG (QEEG) evaluates EEG frequency bands and the theta/beta ratio; the commercially available Neuropsychiatric EEG‑based ADHD Assessment Aid (NEBA) system measures resting theta/beta ratio at the central midline electrode (CZ) and uses proprietary cutoffs to estimate the likelihood of ADHD.

Regulatory/context: The NEBA device received a de novo FDA classification (K112711) and is indicated to measure the theta/beta ratio at electrode CZ in patients 6 to 17 years of age to be used combined with a clinician's evaluation as an aid in diagnosis; it is not intended as a stand‑alone diagnostic tool.

Evidence conclusion: Although a pivotal trial reported high specificity and positive predictive value, the broader literature shows inconsistent findings about theta/beta ratio differences in ADHD and the evidence is insufficient to demonstrate that QEEG assessment of the theta/beta ratio improves diagnostic accuracy or patient health outcomes.

Evidence summary

Definitions and regulatory context

Revision History

12/29/2023administrative_update

Consensus review; references updated without changes to coding or clinical policy statements.

09/27/2024retirement_review

Retirement review conducted.

05/01/2025retirement_effectiveLatest

Policy retired effective 05/01/2025.