Cognitive Rehabilitation - (CPG270)

Cigna covers individualized cognitive rehabilitation only for stroke/cerebral infarction or moderate–severe TBI (specific ICD‑10 codes listed) and considers it not medically necessary for all other indications (including mild TBI/concussion, dementia, developmental disorders, etc.), while coma stimulation (HCPCS S9056) is experimental. Coverage requires documented cognitive impairment with functional compromise, neuropsychological testing/assessment used to plan treatment, patient ability/willingness to participate, expectation of significant functional improvement, a written individualized treatment plan with quantifiable goals and progress documentation (continuation requires documented improvement), appropriate CPT coding (97129/97130) and independent justification for inpatient/residential care per the benefit plan.

"An individualized program of cognitive rehabilitation is considered medically necessary for EITHER of the following: stroke/cerebral infarction or moderate to severe traumatic brain injury (TBI) wh..."