Appeal type: Experimental
Decision: Insurer Denial Upheld

Summary Reviewer 1

A 25-year-old male enrollee has requested reimbursement for quantitative EEG (brain mapping) performed from 7/02/20 through 8/25/20. The Health Insurer has denied this request and reported that the services at issue were investigational for the treatment of the enrolleeAaas medical condition. The physician reviewer found that in a 2017 review of the evidence base for neurofeedback and biofeedback for mood and anxiety disorders, Banerjee and Argaez concluded the following, AaAFive relevant RCTs (randomized controlled trials). . . comparing NF (neurofeedback) or BF (biofeedback) with other psychological treatments or no treatments for managing patients with posttraumatic stress disorder (PTSD), generalized anxiety disorder (GAD) or major depressive disorder (MDD) were identified. Of these five RCTs, two RCTs...were on NF provided by health professionals, and three RCTsAaAwere on BF provided by health professionals. No relevant studies on the clinical effectiveness of biofeedback using home equipment for treatment of PTSD, GAD, or depression without continued support from health professionals were identified. No relevant evidence-based guidelines regarding the use of NF or BF for the treatment of PTSD, GAD, or depression were identifiedAaAFor patients with MDD, one RCT found that patients who received heart rate variability biofeedback (HRV-BF) in addition to psychotherapy showed significant improvements in symptoms after treatment, while significant improvements were not achieved with psychotherapy alone. Findings need to be interpreted in the light of the limitations (such as small sample size, limited number of relevant studies, lack of randomization details, lack of reporting of adverse event, and lack of long-term data).AaA The paucity of data to support the use of EEG neurofeedback/biofeedback for depression is reflected in the fact that this treatment is not mentioned in recent depression guidelines.
In a 2017 overview of the use of biofeedback and neurofeedback in traumatic brain injury, Gray concluded the following, AaANeurofeedback, a type of biofeedback, shows promise in initial research studying its efficacy for treatment of symptoms of TBI. Biofeedback may provide a more concrete, structured approach that might appeal to some populations and/or personality types than others, although the cost of the treatment and equipment, along with the potential for some computer-based interventions to exacerbate symptoms in patients with TBI, may need to be weighed against the potential benefits. Although more research, including blinded randomized controlled trials, is needed on the use of biofeedbackAaaand neurofeedback in particular for TBIAaathe literature suggests that this approach shows promise for treating some symptoms of TBI with this modality. With further advances occurring in technology, including at-home use of neurofeedback devices, preliminary data from the pilot study suggests that survivors of TBI could benefit from improved motivation for treatment and some reduction of symptoms related to attention, mood, and mindfulness with the addition of neurofeedback to mindfulness meditation training. Additional research is needed on the use of neurofeedback, including at-home devices, with veteran populations with brain injuries and should screen for comorbid conditions such as PTSD.AaA
In this case, the patient has a history of anxiety, depression, suicidal ideation, panic attacks, and multiple reported traumatic brain injuries. A review of the literature reveals that there is insufficient data to support quantitative EEG/brain mapping as an effective diagnostic tool or treatment for these conditions. Quantitative EEG/brain mapping is not listed in recent depression guidelines. Therefore, quantitative EEG (brain mapping) performed from 7/02/20 through 8/25/20 was not likely to have been more beneficial than other available standard therapy.