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.

SourceLink

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).

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

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