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Cognitive Rehabilitation Medical Policy Update Effective February 15, 2023

Audience: Physical Medicine and Rehabilitation, and Neurology Providers

Excellus BlueCross BlueShield works to ensure that the development of corporate medical policies occurs through an open, collaborative process. We encourage participating providers to become actively involved in medical policy development. Each month, draft policies are available on our website for review and comment here. Providers now have the capability of attaching supporting documentation related to their comments.

The following updated medical policy has been reviewed and was approved on October 20, 2022, by the Corporate Medical Policy Committee, which includes practitioner representatives from all Health Plan regions.

Corporate Medical Policy 8.01.19 Cognitive Rehabilitation has been updated to be consistent with evidence that cognitive rehabilitation is medically necessary for traumatic brain injury (TBI) only. This updated policy will be effective February 15, 2023.  The policy applies to the services of all practitioners and facilities. The policy does not apply to all lines of business. Benefits are contract-dependent.  Please refer to the medical policy and the member’s subscriber contract.

Corporate Medical Policy 8.01.19 Cognitive Rehabilitation policy criteria was updated as follows:

  • The removal of medical necessity criteria for cerebral vascular accident or stroke.
  • The addition of investigational criteria for post-acute sequelae of SARS CoV-2 infection often referred to as long COVID.

The rationale section of the medical policy provides information related to the Health Plan’s change in coverage criteria based on current body of literature regarding cognitive rehabilitation for long COVID, TBI and stroke.

These services are subject to audit and policy updates at the Health Plan’s discretion. Access the individual policies here.

If you have any questions regarding this policy, please contact your Provider Relations representative.

Thank you for the quality of care and service that you provide to our members.

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