Cost and coverage of neurofeedback therapy for Medicare beneficiaries

Neurofeedback therapy is a type of biofeedback that uses real-time EEG data to train individuals to regulate their own brain activity. It has been shown to be effective for a variety of conditions, including ADHD, anxiety, depression, and PTSD. However, cost and coverage are two of the primary concerns for individuals seeking neurofeedback therapy, especially those who are Medicare beneficiaries.

Medicare coverage for neurofeedback therapy

Medicare, the federal health insurance program for seniors and certain disabled individuals, generally covers medically necessary services. However, as of September 2023, Medicare typically does not provide coverage for neurofeedback therapy.

The Centers for Medicare & Medicaid Services (CMS), which sets Medicare coverage policies, has not yet established a national coverage determination (NCD) for neurofeedback therapy. This means that individual Medicare Advantage (MA) plans and Medicare Part D prescription drug plans have the flexibility to decide whether or not to cover neurofeedback therapy.

Some MA plans and Part D plans do offer coverage for neurofeedback therapy, but these plans are typically limited to certain conditions and may have high out-of-pocket costs. For example, some plans may only cover neurofeedback therapy for ADHD, and others may require that patients have tried other treatments first.

Cost of neurofeedback therapy

The cost of neurofeedback therapy can vary depending on a number of factors, including the location of the provider, the number of sessions needed, and the type of neurofeedback equipment used. However, neurofeedback therapy is typically an out-of-pocket expense for Medicare beneficiaries.

According to a 2022 survey by the Neurofeedback Research Foundation, the average cost of neurofeedback therapy per session is $200-$500. However, some sessions may cost more than $1,000.

Options for Medicare beneficiaries who need neurofeedback therapy

There are a few options available for Medicare beneficiaries who need neurofeedback therapy.

• Pay out-of-pocket: This is the most common option, but it can be expensive.
• Work with a provider who accepts Medicare assignment: Some neurofeedback providers accept Medicare assignment, which means that they will bill Medicare directly and the beneficiary will only be responsible for the coinsurance and deductible.
• File a Medicare medical necessity appeal: If a Medicare beneficiary has tried other treatments for their condition and has not been successful, they may be able to file a Medicare medical necessity appeal to request coverage for neurofeedback therapy.

Advocating for Medicare coverage of neurofeedback therapy

There is a growing movement to advocate for Medicare coverage of neurofeedback therapy. A number of organizations, including the Neurofeedback Research Foundation and the American Academy of Neurofeedback and Biofeedback, are working to raise awareness of the benefits of neurofeedback therapy and to urge CMS to establish a national coverage determination for neurofeedback therapy.

If you are a Medicare beneficiary who is interested in neurofeedback therapy, you can advocate for Medicare coverage by contacting your elected representatives and urging them to support legislation that would require CMS to establish a national coverage determination for neurofeedback therapy.

Here are some specific things you can do:

• Contact your Medicare Advantage plan or Part D plan and ask if they cover neurofeedback therapy.
• If your plan does not cover neurofeedback therapy, ask them why and what they would need to see in order to consider covering it.
• If you have tried other treatments for your condition and have not been successful, ask your doctor to write a letter to your Medicare Advantage plan or Part D plan explaining why they believe neurofeedback therapy is medically necessary for you.
• Contact your elected representatives and urge them to support legislation that would require CMS to establish a national coverage determination for neurofeedback therapy.

Conclusion

Neurofeedback therapy is a promising treatment for a variety of conditions, but cost and coverage are two of the primary concerns for individuals seeking this type of therapy. Medicare beneficiaries who are interested in neurofeedback therapy should be aware that Medicare typically does not provide coverage for this treatment. However, there are a few options available for Medicare beneficiaries, such as paying out-of-pocket, working with a provider who accepts Medicare assignment, or filing a Medicare medical necessity appeal.

If you are a Medicare beneficiary who is interested in neurofeedback therapy, I encourage you to do your research and talk to your doctor about your options. You can also contact your elected representatives and urge them to support legislation that would require CMS to establish a national coverage determination for neurofeedback therapy.