Is Neurofeedback covered by Medicare?

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Is Neurofeedback covered by Medicare? A Short Guide to a Newer Treatment

How does your brain make decisions?

Your brain is like the control center for your body in many ways. It sends signals to parts of your body to let your body know how to react and behave. This is true from the voluntary behaviors like chopping vegetables or kicking a soccer ball. It even controls the involuntary or autonomic system of the body. This regulates your heartbeat, your lungs and your sweat when you’re hot.

Healthy cognitive function

Your brain essentially sends electric signals in order to tell the rest of your body what to do. In an individual with healthy or “normal” cognitive function, this system can work seamlessly their entire lives with no interruption. Their responses and behavior will develop over time according the norms they experience in their environment and the genetic codes they carry from birth.

Divergent Cognitive function

But what happens if you or someone you love experiences atypical or divergent cognitive function or behaviors? These things can show up when a traumatic injury to the brain or a traumatic emotional experience happens. The neural connections breaks, with causes a decrease or complete stop to regulation of your body and systems.

This can show up in many forms including:

  • Attention Deficit Disorder (ADD or ADHD) in kids or adults
  • Seizure syndrome
  • Depression or Anxiety or other mental health issues
  • Post Traumatic Stress Disorder (PTSD)
  • Autism Spectrum Disorder

Many of these are actually quite common among kids and adults. If left unexamined any of these behavioral or emotional issues can cause difficulty for children in school or even for adults in their personal and professional lives as they get older.

While some of these things are manageable with behavioral interventions and medical treatment, Neurofeedback can provide an alternative if these things aren’t effective for a patient.

So What is Neurofeedback?

Neurofeedback is a process by which a patients brain activity and electrical signals are monitored by an EEG (electroencephalogram) in an effort to see where the connectivity may be broken. This can create a new pathway or soften an existing pathway by the brain’s own mapping system. As the patient’s brain reacts in a positive or “desirable” way, positive imagery is shown as a reward.

This encourages a new pathway or new reaction to occur. Over time, this pathway gets stronger by the repetitive treatment allowing the patient to slowly make these responses their new “normal.” Although it is still a bit of a controversial treatment, studies have shown success across a variety of patients. This treatment can help with a variety of conditions–both congenital and non congenital.

Who is it for?

Neurofeedback could be beneficial for anyone who has had a traumatic brain injury. But it has also shown effective for those with other issues resulting from an electrical signal disconnect in the brain. This could be any of but not exclusively the following:

  • attention-deficit disorder (ADD)
  • seizure disorders
  • post-traumatic stress disorder
  • insomnia
  • developmental delays

There are varying degrees of each of these disorders and Neurofeedback could be an option that works when other solutions haven’t.

Sounds Expensive–is Neurofeedback covered by Medicare?

While there are a few private insurance companies that fully cover treatments for Neurofeedback, it’s pretty infrequent that you will find this to be the case. Although Medicare–federally funded health insurance usually only offered to those over the age of 65–often doesn’t typically cover something of this nature. There are some instances in which Neurofeedback is not under Medicare Coverage.

Here are some things to take into consideration when thinking about this:

  • It will likely be dependent on the individual and their circumstances
  • Treatment Cost may vary depending on the reason for the therapy
  • A person’s age
  • Billing Codes

If you are a person that falls under the requirements for Medicare coverage, it would most likely be under Part B. Medicare Part B covers outpatient procedures or treatments. The exception to this would be if the treatment or procedure was preformed in a hospital or nurse center.

If this was the case, it’s possible it would be covered under Medicare Part A–which covers all treatments requiring hospitalization.

One more consideration

If the illness or disorder is a result of a fall or seizure, the possibility exists that a patient will need physical therapy in conjunction with Neurofeedback treatment. Physical therapy may be a prerequisite for Medicare coverage. So if you have a physical therapy requirement, it could help with the question of is Neurofeedback covered by Medicare.

In the end, is Neurofeedback covered by Medicare?

As treatments like Neurofeedback become more mainstream in medical community, coverage can change. So Medicare coverage for this treatment may happen soon. If you are unsure about whether your unique circumstances will allow you coverage under Medicare for Neurofeedback therapy, please reach out to us so we can help you talk through the ins and outs of Medicare coverage.

We are here to help you get everything you need from your Medicare coverage!

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