Clarifying the Code: Historical Foundations, Current Practices, and Ethical Billing in Neurofeedback and QEEG
DOI:
https://doi.org/10.15540/nr.12.2.138Keywords:
Neurofeedback, QEEG, CPT, Billing, InsuranceAbstract
This article addresses the complexities of ethical billing and coding practices for neurofeedback and quantitative EEG (qEEG) services. It explores the historical development of Current Procedural Terminology (CPT) codes related to neurofeedback, examines current best practices in billing, and identifies potential legal and ethical pitfalls, including recent fraud cases. Special attention is given to Medicare’s policies, the nuances of incident to billing, and the role of technicians in service delivery. The paper underscores the importance of documentation, scope-of-practice considerations, and transparency with payers and patients. Additionally, the advocacy efforts of professional organizations such as the International Society for Neuroregulation & Research (ISNR) and the Association for Applied Psychophysiology and Biofeedback (AAPB) are reviewed, particularly their ongoing initiative to update and refine CPT codes to better reflect clinical practice. Through a comprehensive synthesis of guidance from the AMA, CMS, professional ethics codes, and payer policies, the article serves as both a practical guide and a call to uphold ethical standards in the neuroregulation field.
References
American Medical Association [AMA]. (1997). Psychiatric therapeutic, 90875, 90901, 90911 (Q&A). CPT Assistant, 7(9), 11. https://www.findacode.com/newsletters/ama-cpt-assistant/psychiatric-therapeutic-90875-90901-90911-9.html
American Psychological Association [APA]. (2017). Ethical principles of psychologists and code of conduct (2002, Amended 2010, 2017). Author. https://www.apa.org/ethics/code
American Psychological Association [APA]. (2023). Medicare final rule expands telehealth. APA Services. https://www.apaservices.org/practice/reimbursement/government/medicare-inperson-telehealth-requirement
Anthem Blue Cross Blue Shield. (2021). Medical policy CG-MED-97: Biofeedback and neurofeedback. https://www.anthem.com/dam/medpolicies/abc/active/guidelines/gl_pw_e003054.html
Biofeedback Certification International Alliance [BCIA]. (2017). BCIA professional standards and ethical principles. https://www.bcia.org/bcia-professional-standards-ethical-principles
Centers for Medicare & Medicaid Services [CMS]. (2011). Local coverage article: PHYS-066 biofeedback (L31070). https://downloads.cms.gov/medicare-coverage-database/lcd_attachments/31070_1/L31070_PHYS066_CBG_030111.pdf
Centers for Medicare & Medicaid Services [CMS]. (2015, rev. 2020). Billing and coding: Outpatient therapy biofeedback training (A53352). Medicare Coverage Database. https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=53352
Hammond, D. C. (2011). What is neurofeedback: An update. Journal of Neurotherapy, 15(4), 305–336. https://doi.org/10.1080/10874208.2011.623090
International Society for Neuroregulation & Research [ISNR]. (2020). ISNR professional standards and ethical principles (August 2020). International Society for Neuroregulation & Research. https://isnr.org/wp-content/uploads/2020/09/ISNR-Professional-Standards-Code_of_Ethics_8-9-2020.pdf
International Society for Neuroregulation & Research, & Association for Applied Psychophysiology and Biofeedback [ISNR & AAPB]. (2023). CPT code initiative. https://aapb.org/CPT
Office of Inspector General, U.S. Department of Health and Human Services. (2025). Minnesota couple indicted in $15 million medical billing fraud scheme. https://oig.hhs.gov/fraud/enforcement/minnesota-couple-indicted-in-15-million-medical-billing-fraud-scheme/
Providence Health Plan. (2022). Medical policy MP515: Biofeedback and neurofeedback. https://www.providencehealthplan.com/-/media/providence/website/pdfs/providers/medical-policy/mp515.pdf
Successful Practitioner. (2021). Biofeedback, neurofeedback, QEEG – Billing CPT codes. https://successfulpractitioner.com/biofeedback-cpt-codes/
U.S. Attorney’s Office, District of Minnesota. (2025, April 10). Minnesota couple indicted in $15 million medical billing fraud scheme [Press release]. U.S. Department of Justice. https://oig.hhs.gov/fraud/enforcement/minnesota-couple-indicted-in-15-million-medical-billing-fraud-scheme/
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Leslie Sherlin, Robert Longo
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License (CC-BY) that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).
