Cognitive Rehabilitation

This policy covers cognitive rehabilitation as a distinct, definable component of rehabilitation aimed at improving cognitive functions (attention, memory, language, perception, reasoning, executive function) following central nervous system insults—most commonly traumatic brain injury and stroke—delivered as comprehensive outpatient, group-plus-individual, or targeted programs by qualified professionals. Coverage requires prescription and delivery by a licensed provider, demonstrable potential for improvement with sufficient cognitive and language ability to participate, is subject to the member’s benefit plan and state regulations, and excludes indications not specifically listed as covered (e.g., autism spectrum disorder, seizure disorders, multiple sclerosis, Alzheimer disease, brain tumor/post‑cancer treatment, and other noncovered applications).

"Cognitive rehabilitation as a distinct and definable component of rehabilitation for individuals with cognitive impairment due to traumatic brain injury (TBI)."