Table: CPT Codes / HCPCS Codes / ICD-10 Codes CodeĬPT codes covered if selection criteria are met: Please check benefit plan descriptions for details. Coverage of outpatient cognitive rehabilitation is subject to applicable benefit plan terms and limitations for physical and occupational therapy.Cognitive rehabilitation may be performed by a occupational therapist, physical therapist, speech/language pathologist, neuropsychologist or other psychologist, or a neuropsychiatrist, psychiatrist or other physician.Transcranial electrical stimulation for facilitation of post-stroke CR.įootnote1* Note: Cognitive rehabilitation is considered medically necessary for encephalopathy due to HIV when medical necessity criteria in section I above are met.EyeBox device for the diagnosis of mild traumatic brain injury (TBI) or concussion.Combined motor and cognitive rehabilitation for individuals with mild cognitive impairment (MCI).Coma stimulation, also known as the "Responsiveness Program" (cognitive remediation of comatose persons), coma arousal program/therapy, sensory stimulation, and multi-sensory stimulation programs for coma and persistent vegetative state.Treatment of epilepsy/seizure disorders.Mild traumatic brain injury (TBI) (including sports-related concussion).Dementia (e.g., from Alzheimer’s disease, HIV-infection Footnote1*, or Parkinson’s disease).Cognitive decline in multiple sclerosis (MS) and chronic obstructive pulmonary disease (COPD).Behavioral/psychiatric disorders such as addiction, attention-deficit/hyperactivity disorder (ADHD), bipolar disorder, depression, schizophrenia, social phobia, substance use disorders (SUD), and autism spectrum disorders (ASD).The following cognitive rehabilitation indications, programs, services are considered experimental and investigational because the effectiveness of these approaches has not been established:Ĭognitive rehabilitation for the following indications (not an all-inclusive list): For language and communication deficits, persons usually receive 8 hours of weekly therapy, beginning at 4 weeks post-onset and continuing up to 48 weeks post-onset. Note: Rehabilitation for visuo-spatial deficits generally entails 20 1-hour sessions delivered over the course of 4 weeks. The member is expected to make significant cognitive improvement.The member is able to actively participate in a cognitive rehabilitation program (eg, is not comatose or in a vegetative state) and.The member has been seen and evaluated by a psychiatrist or psychologist and.The cognitive deficits have been acquired as a result of neurologic impairment due to moderate to severe traumatic brain injury, brain surgery, stroke, or encephalopathy and.Neuropsychological testing has been performed and neuropsychological results will be used in treatment-planning and directing rehabilitation strategies and.This Clinical Policy Bulletin addresses cognitive rehabilitation.Īetna considers cognitive rehabilitation as adjunctive treatment of cognitive deficits (e.g., attention, language, memory, reasoning, executive functions, problem solving, and visual processing) medically necessary when performed by a licensed health care professional acting within their scope of practice and all of the following are met: Number: 0214 Table Of Contents Policy Applicable CPT / HCPCS / ICD-10 Codes Background References
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