Medical Policy
Medical Policy
Policy Num: 02.001.049
Policy Name: Hypnosis
Policy ID: [02.001.049][Ar B M+ P][2.01.06]
Last Review: April 5, 2019
Next Review: Policy archived
Issue: April: 2019
ARCHIVED
Related Policies: 3.01.01 Psychtherapy
| Popultation Reference No. | Populations | Interventions | Comparators | Outcomes |
|---|---|---|---|---|
| 1 | Individuals:
|
Interventions of interest are:
|
Comparators of interest are:
|
Relevant outcomes include:
|
| 2 | Individuals:
|
Interventions of interest are:
|
Comparators of interest are:
|
Relevant outcomes include:
|
| 3 |
Individuals:
|
Interventions of interest are:
|
Interventions of interest are:
|
Relevant outcomes include:
|
Hypnosis is an induced state in which there is an increased amenability and responsiveness to suggestions and commands. Hypnosis is not intended to cure disease but rather to relieve symptoms of illness
The objective of this review is to discuss the role of medical hypnosis, complementary and alternative therapies, in the area of pain and in the area of behavior modification.
Hypnosis is considered medically necessary when used to control acute or chronic pain, or as an adjunct to psychotherapy. Hypnosis used as an anesthesia is considered not medically necessary.
Hypnosis is an integral part of a medical visit at the level of care rendered (e.g. brief, intermediate) or as an integral part of psychotherapy. It is not a separate benefit.
The Federal Employee Health Benefit Program (FEHBP/FEP) requires that procedures, devices or laboratory tests approved by the U.S. Food and Drug Administration (FDA) may not be considered investigational and thus these procedures, devices or laboratory tests may be assessed only on the basis of their medical necessity.
BlueCard/National Account Issues
Hypnosis is payable as an integral part of a medical visit at the level of care rendered (e.g., brief, intermediate, physical therapy) or as an integral part of psychotherapy. It is not a separate benefit.
Hypnosis is the induction of a deeply relaxed state, with increased suggestibility and suspension of critical faculties. Once in this state, sometimes called a hypnotic trance, patients are given therapeutic suggestions to encourage changes in behaviour or relief of symptoms. For example, in a treatment to stop smoking a hypnosis practitioner might suggest that the patient will no longer find smoking pleasurable or necessary. Hypnosis for a patient with arthritis might include a suggestion that the pain can be turned down like the volume of a radio.
Hypnotic trance—A deeply relaxed state with increased suggestibility and suspension of critical faculties
Direct hypnotic suggestion—Suggestion made to a person in a hypnotic trance that alters behaviour or perception while the trance persists (for example, the suggestion that pain is not a problem for a woman under hypnosis during labour)
Post-hypnotic suggestion—Suggestion made to a person in a hypnotic trance that alters behaviour or perception after the trance ends (for example, the suggestion that in the future a patient will be able to relax at will and will no longer be troubled by panic attacks)
The primary uses of hypnosis and relaxation techniques are in anxiety, in disorders with a strong psychological component (such as asthma and irritable bowel syndrome), and in conditions that can be modulated by levels of arousal (such as pain). They are also commonly used in programmes for stress management.
There is good evidence from randomised controlled trials that both hypnosis and relaxation techniques can reduce anxiety, particularly that related to stressful situations such as receiving chemotherapy. They are also effective for panic disorders and insomnia, particularly when integrated into a package of cognitive therapy (including, for example, sleep hygiene). A systematic review has found that hypnosis enhances the effects of cognitive behavioural therapy for conditions such as phobia, obesity, and anxiety.
N/A
A search of the literature was completed through the MEDLINE database for the period of January 1992 through April 1995. The search strategy focused on references containing the following Medical Subject
Headings:
- Hypnosis
Research was limited to English-language journals on humans.
Population Reference No. 1 Policy Statement
For individuals with acute or chronic pain. Intervention of interest is medical hypnosis. Comparators of interest are pharmacotheraphy and other therapies availabe. Relevant outcomes include improvement in pain control. The evidence suggest some improvement in the net health outcome.
| Population Reference No. 1 Policy Statement | [X] Medically Necessary | [ ] Investigational | [ ] Not Medically Necessary |
Population Reference No. 2 Policy Statement
For individuals with necessity of anesthesia. Intervention of interest is medical hypnosis. Comparators of interest are anaesthetic agents. Relevant outcomes include improvement in pain control. The evidence is insufficient to determine the effects of the technology on health outcomes.
| Population Reference No. 2 Policy Statement | [ ] Medically Necessary | [X] Investigational | [ ] Not Medically Necessary |
Population Reference No. 3 Policy Statement
For individuals with mood disorders. Intervention of interest is medical hypnosis. Comparators of interest are psychotherapy without hypnotherapy. Relevant outcomes include imporvement in quality of life and relief of symptoms. The evidence is insufficient to determine the effects of the technology on health outcomes.
| Population Reference No. 3 Policy Statement | [ ] Medically Necessary | [X] Investigational | [ ] Not Medically Necessary |
N/A
The American Psychological Association
APA Position: 1. Hypnosis should be employed by psychiatrists or other health care professionals with appropriate licensure and training, and it should be implemented within the scope of their professional expertise. 2. Hypnosis should be implemented in the context of a thorough medical and psychiatric evaluation, and its delivery should be consistent with the treatment plan for that patient. 3. The induction and termination of the trance state should be clearly structured and consistent with evidence-based hypnosis practice. 4. Hypnosis training should be delivered by professionally credentialed individuals and, optimally, includes both didactic education and supervised clinical contact.
There is currently a Local Coverage Determination (LCD) for psychiatry and psychology services. Please refer to the following LCD website for Medicare Members: https://www.cms.gov/medicare-coverage-database/details/lcddetails.aspx?LCDId=33632&ContrId=298&ver=36&ContrVer=1&CntrctrSelected=298*1&Cntrctr=298&name=Nation al+Government+Services%2c+Inc.+(13201%2c+A+and+B+and+HHH+MAC%2c+J+- +K)&s=All&DocType=Active&bc=AggAAAQAAAAAAA%3d%3d&
| Codes | Number | Description |
|---|---|---|
| CPT | 90880 | Hypnotherapy |
| ICD10 | Investigational for al diagnoses as a stand-alone procedure |
| Date | Action | Description |
|---|---|---|
| 04/05/2019 | Annual review | New policy format, status changed to archived |
| 09/15/2016 | ||
| 10/25/2014 |
| Applicable Specialties | Medical hynotherapist | |
| Preauthorization required | [ ] Yes | [X] No |
| Preauthorization requirements | N/A | |
| Place of Service | outpatient / office | |
| Age Limit | no age limit | |
| Frequency | ||
| Frequency Limit | no frequency limit | |
| Gender | [X] Male | [X] Female |
Configure 90880 to deny for ALL broad diagnosis.
| [ ] YES | [X] NO |
| Description: | |
| [ ] YES If Yes, describe the comparison between Interqual criteria and this Policy |
[X] NO |
|
DESCRIBE THE COMPARISON BETWEEN INTERQUAL CRITERIA AND THIS POLICY: |
|
|
[ ] LOCAL If Local, specify Rationale: |
[X] BCBSA |
|
SPECIFY RATIONALE: |
|
|
Approved By: Date: |