CurrentUnitedHealthcarePolicy CS020.S

Cognitive Rehabilitation and Coma Stimulation

Defines UnitedHealthcare's outpatient coverage stance for Cognitive Rehabilitation (CR) and the noncoverage stance for Coma Stimulation for Disorders of Consciousness; applies to commercial plans except where state-specific policies override.

Policy Summary

PayerUnitedHealthcare

PolicyCognitive Rehabilitation and Coma Stimulation

Policy CodePolicy CS020.S

Change TypeTitle change; application and content updates

Effective DateDec 1, 2025

Next Review Date

Key ActionProviders must reference and meet the InterQual® LOC: Outpatient Rehabilitation & Chiropractic clinical criteria to substantiate medical necessity for outpatient Cognitive Rehabilitation prior to coverage decisions; InterQual criteria drive coverage determinations.

POLICY UPDATE CHANGES

Title changed and coverage rationale language refined to specify Coma Stimulation is not medically necessary for any Disorder of Consciousness (DOC).

Application exclusions updated for multiple states (Idaho, Nebraska, New Jersey, New Mexico, North Carolina, Ohio, Pennsylvania, Tennessee, Kentucky, Indiana, Kansas) referencing state-specific policies.

Supporting information, description of services, clinical evidence, and references updated to current information.

1Outpatient service type covered

1Service type not covered (Coma Stimulation for DOC)

InterQualExternal clinical criteria referenced

Coverage Summary

This policy (Policy Number CS020.S, effective December 1, 2025, last reviewed April 1, 2026) defines UnitedHealthcare's outpatient coverage stance for Cognitive Rehabilitation (CR) and the noncoverage stance for Coma Stimulation for Disorders of Consciousness (DOC). The policy applies to commercial plans except where state-specific policies override and is limited to outpatient Cognitive Rehabilitation services only.

UnitedHealthcare's coverage position is mixed: outpatient Cognitive Rehabilitation is considered proven and medically necessary under certain circumstances when medical necessity criteria are met per InterQual® LOC: Outpatient Rehabilitation & Chiropractic, while Coma Stimulation (also called coma arousal, coma responsiveness, multisensory stimulation, or coma care programs) is considered unproven and not medically necessary for any Disorder of Consciousness (DOC).

Policy Metadata

Policy numberCS020.S

Effective dateDecember 1, 2025

Last reviewApril 1, 2026

StatusCURRENT

Coverage stanceMixed — Outpatient Cognitive Rehabilitation covered when InterQual criteria met; Coma Stimulation for any Disorder of Consciousness not medically necessary

External clinical criteria referencedInterQual® LOC: Outpatient Rehabilitation & Chiropractic

Key statsOutpatient service type covered; Service not covered: Coma Stimulation for DOC; External criteria: InterQual

Medical-Necessity Criteria

Cognitive Rehabilitation (Outpatient) - Medical Necessity

Covered when ALL of the following are met:

ALL of the following

Service is outpatient Cognitive Rehabilitation (policy applies to outpatient CR only).
Medical necessity clinical coverage criteria are met per InterQual® LOC: Outpatient Rehabilitation & Chiropractic (refer to InterQual criteria).

Coma Stimulation / Coma Arousal / Multisensory Stimulation

Not medically necessary when intended to treat any Disorder of Consciousness (DOC):

Coma Stimulation (also known as coma arousal, coma responsiveness, multisensory stimulation, and coma care therapy/programs) is unproven and not medically necessary for any Disorder of Consciousness (DOC), including coma, vegetative state, or minimally conscious state.

Coding

Cognitive Rehabilitation CPT Codes (reference only)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 HCPCS Code (reference only)HCPCSNot Covered

S9056

Coma stimulation per diem.

Provider Actions

Prior Authorization

Reference InterQual for medical necessity determination

Providers must reference and meet the InterQual® LOC: Outpatient Rehabilitation & Chiropractic clinical criteria to substantiate medical necessity for outpatient Cognitive Rehabilitation prior to coverage decisions. InterQual criteria drive coverage determinations for outpatient Cognitive Rehabilitation.

97129
97130

Denial Risk

Coma Stimulation coverage denial

Claims for Coma Stimulation intended to treat any Disorder of Consciousness (DOC) are considered unproven and not medically necessary and are subject to denial.

Background & Evidence

Cognitive Rehabilitation (CR) is defined as a multidisciplinary treatment program aimed at improving cognitive function and retraining abilities such as memory, attention, language, reasoning, and problem-solving to maximize functional independence. CR includes both restorative approaches (strengthening or restoring skills through progressively challenging tasks) and compensatory approaches (teaching strategies to bypass or compensate for impairments). UnitedHealthcare covers outpatient CR when medical necessity clinical coverage criteria are met per InterQual® LOC: Outpatient Rehabilitation & Chiropractic.

Coma Stimulation refers to the use of multimodal sensory stimulation intended to speed recovery from coma or improve arousal level in individuals with disorders of consciousness. The literature reports no established protocols or definitive patient selection criteria, and systematic reviews and guidelines indicate heterogeneous evidence with insufficient high-quality data demonstrating consistent, reproducible benefit; therefore, Coma Stimulation is considered unproven and not medically necessary for any Disorder of Consciousness (DOC).

Definitions

Cognitive Rehabilitation (CR)A multidisciplinary treatment program to improve cognitive function and retrain abilities (memory, attention, language, reasoning, problem-solving) to maximize functional independence.

Coma StimulationUse of multimodal sensory stimulation in an attempt to speed recovery from coma or improve arousal level; proposed to promote awakening but lacks established protocols and definitive patient selection criteria.

Revision History

2025-12-01material_change

Title changed and coverage rationale language refined to specify Coma Stimulation is not medically necessary for any Disorder of Consciousness (DOC); added DOC definition; archived prior version CS020.R.

2026-03-01application_update

Application updates: updated reference link to reflect the current title for state-specific policy versions (Idaho and Pennsylvania).

2026-01-01application_update

Application updates: added language that this Medical Policy does not apply to the states of Nebraska and North Carolina; refer to state-specific policy versions.

Source	Summary
InterQual referenced	InterQual® LOC: Outpatient Rehabilitation & Chiropractic defines the clinical necessity criteria for outpatient Cognitive Rehabilitation and is used to determine medical necessity.
Systematic review/meta-analysis (Kumar 2024)	Kumar et al. (2024) systematic review/meta-analysis found mixed results: sensory stimulation showed the largest pre-post effect but overall evidence across interventions for Disorders of Consciousness was insufficient to establish efficacy for coma stimulation.
AAN guideline (Giacino 2018, reaffirmed 2021)	American Academy of Neurology guideline does not endorse stimulation as a supported treatment for prolonged Disorders of Consciousness and recommends counseling families about limitations of existing evidence.