CurrentColorado Rocky Mountain Health PlansPolicy 2026T0144HH

Cognitive Rehabilitation and Coma Stimulation

Outpatient Cognitive Rehabilitation services coverage for UnitedHealthcare Commercial and Individual Exchange plans (excludes Oxford benefit plans); inpatient services governed by member-specific benefit documents. Policy states cognitive rehabilitation is proven and medically necessary under certain circumstances per InterQual LOC: Outpatient Rehabilitation & Chiropractic; Coma Stimulation is unproven and not medically necessary for Disorders of Consciousness.

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicyCognitive Rehabilitation and Coma Stimulation

Policy CodePolicy 2026T0144HH

Change TypeAdministrative and reference updates

Effective DateJan 1, 2026

Next Review Date

Key ActionProviders must reference InterQual® LOC: Outpatient Rehabilitation & Chiropractic to determine medical necessity for outpatient Cognitive Rehabilitation; coverage follows those clinical criteria.

POLICY UPDATE CHANGES

01/01/2026 - Application: Added language to indicate this Medical Policy does not apply to Oxford benefit plans; Supporting Information: Archived previous policy version 2025T0144GG.

06/01/2026 - Related Policies: Updated reference link to reflect the current Medicare Advantage policy title for Skilled Nursing Facility, Rehabilitation, Long-Term Acute Care Hospital, and Private Duty Nursing.

2Core Coverage Positions

1Not Medically Necessary Positions

1External criteria referenced (InterQual)

Coverage Summary

Overview: This policy (Policy Number 2026T0144HH; effective January 1, 2026; last reviewed June 1, 2026) covers outpatient Cognitive Rehabilitation for UnitedHealthcare Commercial and Individual Exchange plans (excludes Oxford benefit plans). High-level positions: Cognitive Rehabilitation (CR) is covered when the InterQual® LOC: Outpatient Rehabilitation & Chiropractic medical necessity criteria are met; Coma Stimulation (multimodal sensory stimulation for Disorders of Consciousness) is considered unproven and not medically necessary.

Policy at a glance

Policy Number2026T0144HH

Effective DateJanuary 1, 2026

Last ReviewJune 1, 2026

StatusCURRENT

Coverage Stancemixed — Outpatient Cognitive Rehabilitation covered when InterQual LOC met; Coma Stimulation unproven and not medically necessary for Disorders of Consciousness

Medical Necessity Criteria

Cognitive Rehabilitation (CR) - Medical Necessity

Covered when ALL of the following are met per InterQual LOC: Outpatient Rehabilitation & Chiropractic:

ALL of the following

Service is outpatient Cognitive Rehabilitation
Member meets InterQual® LOC: Outpatient Rehabilitation & Chiropractic medical necessity criteria

Clinical coverage rules and authorization specifics are determined by the external InterQual® LOC: Outpatient Rehabilitation & Chiropractic criteria. Providers must reference those InterQual clinical criteria to determine medical necessity and prior authorization requirements for outpatient Cognitive Rehabilitation services.

Not Medically Necessary / Experimental

Coma Stimulation / Coma Arousal

Not medically necessary:

Use of multimodal sensory stimulation (coma stimulation/coma arousal/multisensory stimulation/coma care therapy/programs) for any Disorder of Consciousness (DOC) is considered unproven and not medically necessary

Insufficient evidence of efficacy for any DOC per policy

Definition note: Coma Stimulation is defined as the use of multimodal sensory stimulation to promote awakening or improve arousal in disorders of consciousness (also called coma arousal, multisensory stimulation, or coma care therapy/programs). The policy lists HCPCS code S9056 (coma stimulation per diem) and identifies coma stimulation as not covered/not medically necessary.

Coding

Cognitive Rehabilitation CPT codes (reference)CPTCovered

97129	Therapeutic interventions that focus on cognitive function (e.g., attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity; direct (one-on-one) patient contact; initial 15 minutes.
97130	Therapeutic interventions that focus on cognitive function (e.g., attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity; direct (one-on-one) patient contact; each additional 15 minutes (List separately in addition to code for primary procedure).

Coma Stimulation per diem code (reference)HCPCSNot Covered

S9056

Coma stimulation per diem

Provider Actions

Prior Authorization

Reference InterQual criteria for authorization

Providers must reference InterQual® LOC: Outpatient Rehabilitation & Chiropractic to determine medical necessity for outpatient Cognitive Rehabilitation; coverage follows those clinical criteria.

97129
97130
Reference InterQual LOC: Outpatient Rehabilitation & Chiropractic

Denial Risk

Coma Stimulation not payable

Claims for coma stimulation (including S9056) for Disorders of Consciousness are considered not medically necessary and may be denied as unsupported by evidence.

S9056
Claims for coma stimulation may be denied

Documentation Required

Member specific benefit and applicable mandates

Providers must check the member specific benefit plan document and applicable federal/state mandates; in case of conflict, the member specific plan governs.

Background & Evidence

Background: Cognitive Rehabilitation is a multidisciplinary outpatient treatment that uses restorative and compensatory approaches to improve cognitive domains such as memory, attention, executive function, language, and visuoperceptual skills, with the goal of maximizing functional independence. Coma Stimulation proposes multimodal sensory stimulation to improve arousal or speed recovery from coma or other disorders of consciousness; however, there are no established protocols or definitive patient selection criteria for coma stimulation.

Evidence summary: The evidence supports Cognitive Rehabilitation when InterQual criteria for outpatient CR are met; available studies and systematic reviews show mixed quality and results across diagnoses. In contrast, coma stimulation (multimodal sensory stimulation) lacks consistent, high-quality evidence and is considered unproven and not medically necessary for disorders of consciousness.

Key Definitions

Cognitive Rehabilitation (CR)A multidisciplinary treatment program designed to improve cognitive function and retrain an individual's ability to think, use judgment, and make decisions; includes restorative and compensatory approaches.

Coma StimulationUse of multimodal sensory stimulation to promote awakening from coma or improve arousal level; also called coma arousal, coma responsiveness, multisensory stimulation, and coma care therapy/programs.

Disorder of Consciousness (DOC)A state of prolonged altered consciousness categorized as coma, vegetative state, or minimally conscious state based on neurobehavioral function.

Revision History

01/01/2026administrative_update

Application: Added language clarifying the Medical Policy does not apply to Oxford benefit plans; Supporting Information: Archived previous policy version 2025T0144GG.

06/01/2026reference_updateLatest

Related Policies: Updated reference link to reflect the current Medicare Advantage policy title for Skilled Nursing Facility, Rehabilitation, Long-Term Acute Care Hospital, and Private Duty Nursing.