CurrentOptumPolicy BH727NFB062025

Neurofeedback/Biofeedback for Behavioral and Substance Use Disorders

Defines Optum's behavioral clinical policy position on the medical necessity and coverage of neurofeedback/biofeedback (including EEG-guided and fMRI-guided modalities) for behavioral and substance use disorders, provides evidence review, applicable CPT codes for reference, FDA/CMS context, and guideline citations.

Policy Summary

PayerOptum

PolicyNeurofeedback/Biofeedback for Behavioral and Substance Use Disorders

Policy CodePolicy BH727NFB062025

Change TypeReference/sourcing updates

Effective Date

Next Review Date

Key ActionReview member eligibility, the member-specific benefit plan coverage, and any federal or state mandates that supersede the guideline before applying this policy.

POLICY UPDATE CHANGES

06/16/2025: Annual review; updated references/sourcing and approved by Optum committees on 6/16/2025 and 07/22/2025.

06/18/2024: Annual review: updates to references/sourcing.

07/18/2023: Annual review: updates to references/sourcing.

06/21/2022: Annual review: updates to references/sourcing.

06/21/2021: Annual review: updates to references/sourcing.

06/15/2020: Annual review: updates to references/sourcing.

7+Not medically necessary examples listed

3Reference CPT codes provided

multipleSystematic reviews / RCTs referenced

References and appendices cited

Coverage Summary

Optum policy BH727NFB062025 (last review 2025-06-16) addresses neurofeedback/biofeedback for behavioral and substance use disorders and takes a not covered / not medically necessary stance for those indications. The policy scope defines Optum's Behavioral Clinical Policies for coverage determinations and references evidence and CPT codes to inform decisions.

High-level evidence summary: randomized controlled trials and systematic reviews do not clearly demonstrate effectiveness; studies are heterogeneous, small, often unblinded, and lack durable effects, so neurofeedback/biofeedback is considered unproven and not medically necessary for behavioral or substance use disorders.

At-a-glance metrics

Reference CPT codes provided3

Systematic reviews / RCTs referencedmultiple

Examples of behavioral/substance indications listed as not medically necessary7+

References and appendices cited~40

Revision history notesAnnual reference/source updates (2020-2025)

Medical Necessity / Noncoverage Determinations

Medically Necessary Determination

Neurofeedback/biofeedback is considered not medically necessary for behavioral or substance use disorders when used for those indications.

ALL of the following

Includes but not limited to
- Attention-deficit/hyperactivity disorder (ADHD)
- Depression
- Anxiety
- Obsessive-compulsive disorder

Coding

Reference CPT codes (inclusion does not imply coverage)CPT

90875	Individual psychophysiological therapy incorporating biofeedback training by any modality (face-to-face with the patient), with psychotherapy; 30 minutes
90876	Individual psychophysiological therapy incorporating biofeedback training by any modality (face-to-face with the patient), with psychotherapy; 45 minutes
90901	Biofeedback training by any modality

CPT code descriptions included in documentCPT

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); 30 minutes.
90876	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); 45 minutes.
90901	Biofeedback training by any modality.

Provider Actions / Documentation

Documentation Required

Verify member-specific benefits and regulatory requirements

Review member eligibility, the member-specific benefit plan coverage, and any federal or state mandates that supersede the guideline before applying this policy.

Eligibility verification
Confirm member-specific benefit plan coverage (limits, exclusions)
Check federal or state regulatory mandates that may supersede the guideline

Documentation Required

Clinical rationale documentation

If neurofeedback/biofeedback is requested, document clinical justification, prior treatments, and rationale; note that evidence is insufficient to support medical necessity for behavioral/substance use disorders.

Background and Evidence Summary

Background: Neurofeedback/biofeedback are noninvasive techniques using real-time physiologic monitors (for example EEG, HRV/RSA, MEG, rtfMRI) to provide feedback that enables individuals to modify physiologic functions and mental states. Optum's Behavioral Clinical Policies standardize coverage determinations for behavioral health benefit plans they manage and guide reviewers to check member-specific benefits and regulatory requirements before applying this guideline.

Glossary/Definitions: Neurofeedback/biofeedback — non-invasive techniques using real-time physiologic monitors (EEG, HRV/RSA, MEG, rtfMRI) to provide feedback to individuals to modify physiologic functions and mental states.

Glossary/Definitions: Biofeedback device — as referenced to FDA regulations (CFR Subchapter H, Section 882.5050) for classification and regulatory context.

Policy scope note: CPT codes provided for reference include 90875, 90876, and 90901 (inclusion does not imply coverage); FDA classifies biofeedback devices as Class II and exempt from 510(k) premarket notification requirements.

Overall evidence summaryRandomized trials and systematic reviews do not clearly demonstrate effectiveness; studies are heterogeneous, small, often unblinded, and lack durable effects.

Notable findings - ADHDMultiple systematic reviews/meta-analyses show mixed or low-strength evidence; some RCTs find no superiority over sham/control; medications have stronger evidence.

Medicare Determinations

Name	Number/Type
Biofeedback Therapy
Biofeedback Therapy for the Treatment of Urinary Incontinence

Revision History

06/15/2020revised

Annual review: updates to references/sourcing. (Reference update only; non-material change)

06/21/2021revised

Annual review: updates to references/sourcing. (Reference update only; non-material change)

06/21/2022revised

Annual review: updates to references/sourcing. (Reference update only; non-material change)

Policy Summary

PayerOptum

PolicyNeurofeedback/Biofeedback for Behavioral and Substance Use Disorders

Policy CodePolicy BH727NFB062025

Change TypeReference/sourcing updates

Effective Date

Next Review Date

Key ActionReview member eligibility, the member-specific benefit plan coverage, and any federal or state mandates that supersede the guideline before applying this policy.

On This Page

Post-traumatic stress disorder

Autism spectrum disorder

Coverage statements and criteria (not present in this part)

This document part contains references, CPT descriptors, appendices and revision history; no new clinical coverage criteria are provided here.

No specific medical necessity coverage criteria are included in this part of the policy; refer to Part 1 for initial/continuation criteria and coverage decisions.

Document prior treatments tried (medications, psychotherapy, other interventions) and response
Provide clinical rationale for neurofeedback/biofeedback and specific treatment goals
Note: Reviewed evidence does not clearly demonstrate effectiveness for behavioral or substance use disorders

Documentation Required

Reference and evidence documentation required for coverage decisions

Policy references and evidence summaries are provided to support coverage positions; providers should refer to the full policy (Part 1) for required documentation and medical necessity criteria.

Referenced CPT codes: 90875, 90876, 90901
See Part 1 of the policy for required documentation and medical necessity criteria

Notable findings - Depression/PTSD/OtherSome small studies and meta-analyses report within-group improvements or significant effects in specific analyses, but heterogeneity, methodological limitations, and limited durability preclude firm conclusions.

Selected evidence typesSystematic reviews, randomized controlled trials, meta-analyses, clinical practice guidelines, FDA device classification

07/18/2023revised

Annual review: updates to references/sourcing. (Reference update only; non-material change)

06/18/2024revised

Annual review: updates to references/sourcing. (Reference update only; non-material change)

06/16/2025clarifiedLatest

Annual review; updated references/sourcing and approved by Optum committees on 6/16/2025 and 07/22/2025. (Reference update only; non-material change)