S9056 — Coma stimulation per diem
HCPCS/CPT
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- Medical necessity must be demonstrated per InterQual® LOC: Outpatient Rehabilitation & Chiropractic — clinical documentation should support that InterQual criteria are met (policy refers providers to the InterQual criteria).
- Reference and adherence to the member-specific benefit plan document is required when deciding coverage; the member-specific plan document governs in the event of a conflict.
- For inpatient services or situations not covered by this outpatient policy, documentation should reference the member-specific benefit document and applicable inpatient criteria (policy explicitly directs to member-specific benefits for inpatient services).
- The policy does not list additional explicit documentation checklists (e.g., specific test results or forms); providers are instructed to use InterQual criteria and member-specific benefit plan requirements to determine and document medical necessity.
Key Coverage Criteria
- Outpatient Cognitive Rehabilitation (CR) services only.
- Cognitive Rehabilitation (CR) is proven and medically necessary under certain circumstances; medical necessity clinical coverage criteria are determined by and should meet the InterQual® LOC: Outpatient Rehabilitation & Chiropractic.
- CR directed at improving deficits in memory, attention, perception, visual processing, language, reasoning, learning, planning, judgment, problem-solving, and executive function (per policy definition).
- Investigational/Study contexts noted in clinical evidence where CR has been evaluated (policy describes investigation of CR for disorders including cerebral palsy, Down syndrome, Alzheimer's disease, schizophrenia, attention deficit hyperactivity disorder (ADHD), multiple sclerosis, autism spectrum disorders (ASD), Parkinson's disease, and cognitive dysfunction following COVID-19/long COVID) — these are described as investigated in the literature (evidence limited) and not automatically guarante [...]
- ICD-10 G92.00 - G92.9 Toxic encephalopathy (covered if selection criteria are met).
- Rehabilitation for visuo-spatial deficits (generally entails 20 1-hour sessions delivered over the course of 4 weeks).
6 Active Policies
CIGNA-CPG270 — Cognitive Rehabilitation - (CPG270)
UHC-POL-cognitive-rehabilitation — Cognitive Rehabilitation and Coma Stimulation
AETNA-CPB-0214 — Cognitive Rehabilitation
ANTHEM-MED.00011 — MED.00011 Sensory Stimulation for Brain-Injured Individuals in Coma or Vegetative State
UMR-POL-UMR-cognitive-rehabilitation — Cognitive Rehabilitation and Coma Stimulation
Related Codes
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