We want you to experience the benefits of neurofeedback. All insurers are different, so we have provided helpful tips to guide you through a conversation with your insurer about coverage for neurofeedback.
Yes, you can contact your insurer directly. We recommend you use the following talking points to ensure you get all the information you need. Before beginning the conversation, we recommend clients talk to their medical provider and obtain a letter or notes including a diagnosis code (ICD-10 code) for the condition that you are seeking treatment for.
I am interested in seeing a provider for a qEEG brain map (CPT code 95957) and for neurofeedback therapy (CPT code 90901) in an office setting at the offices of Kaka Ray (see below for details). Am I covered for these procedures, or do I need to be pre-certified prior to beginning treatment?
Your insurer may require you provide a diagnosis code for the presenting issue. This code would be provided by your current physician, therapist, or psychiatrist. The technical term is an ICD-10 code.
Do I have out-of-network benefits that cover these procedures? TNNFB is at out-of-network provider.
If not, you can request a “network adequacy” check to see if there are other in-network providers in your vicinity. This is commonly referred to as a single case agreement.
If the network adequacy request is approved, your insurer would treat TNNFB as an in-network provider for you.
Can you explain my policy’s coverage for these services? What would I need to pay to reach my deductible? Is there a copay for these services? What is the co-insurance rate? Is there a maximum number of sessions I may attend?
Kaka Ray, LMFT, BCN
KLR Therapy LLC
5409 Maryland Way, Suite 305
Brentwood, TN 37027