Appeal type: Experimental/Investigational
Decision: Upheld Decision of Health Plan

Nature of Statutory Criteria/Case Summary: An enrollee has requested reimbursement for brain-based Neurofeedback/Biofeedback and Quantative EEG brain mapping and brain imaging services.Findings: Two out of three physician reviewers found that the brain-based Neurofeedback/Biofeedback and Quantative EEG brain mapping and brain imaging services at issue were not likely to be more beneficial than any other available standard treatments for the enrollees condition.Researchers performed a review of the evidence base for neurofeedback and biofeedback for mood and anxiety disorders and concluded that neurofeedback may be effective for the treatment of PTSD or generalized anxiety disorder compared with no treatment. The researchers also concluded that some evidence was identified to suggest that adding biofeedback to treatment as usual may be more effective than treatment as usual alone. The lack of data to support the use of EEG neurofeedback/biofeedback for depression is reflected by the fact that this treatment is not mentioned in recent depression guidelines. For example, 2016 VA/DoD Clinical Practice Guidelines for the Management of Major Depressive Disorder do not mention EEG neurofeedback/biofeedback as an alternative treatment. The United Kingdoms 2018 National Institute for Health and Care Excellence (NICE) 2018 guidelines for PTSD do not reference EEG neurofeedback/biofeedback. A 2017 overview of the use of biofeedback and neurofeedback in traumatic brain injury concluded that although more research, including blinded randomized controlled studies, is needed on the use of neurofeedback for traumatic brain injury, the literature suggests that this approach shows promise for treating some symptoms of traumatic brain injury with this modality.In this case, the patient had a history of multiple psychiatric diagnoses, with risky behaviors, and multiple past medication trials. A review of the literature indicates that there is currently insufficient evidence to conclude that EEG neurofeedback/biofeedback is likely to be more effective than standard care for any of his symptoms. EEG neurofeedback/biofeedback has not been recommended in the current treatment guidelines for mood disorders, PTSD, or anxiety disorders. The data addressing the use of these techniques with traumatic brain injury are preliminary, with more quality data needed for proof of efficacy before these approaches would be recommended. Thus, the brain-based Neurofeedback/Biofeedback and Quantative EEG brain mapping and brain imaging services at issue to treat the patients condition (Major Depression, Traumatic Brain Injury, PTSD, Anxiety, Suicidal Ideation) were not likely to be more beneficial than any other available standard therapy for the patients condition.Final Result: The reviewers determined that the services at issue were not likely to be more beneficial than any other available standard therapy for the patients condition. Therefore, the Health Plans denial should be upheld.Credentials/Qualifications: Physician reviewers 1, and 3 are board certified in neurology and are actively practicing. Physician reviewer 2 is board certified in psychiatry and is actively practicing. All three reviewers are experts in the treatment of the enrollees medical condition and are knowledgeable about the proposed treatment through recent or current actual clinical experience treating those with the same or a similar medical condition.