Cognitive rehabilitation is a therapeutic approach designed to improve cognitive functioning after central nervous system insult. It includes an assembly of therapy methods that retrain or alleviate problems caused by deficits in attention, visual processing, language, memory, reasoning, problem-solving, and executive functions. Cognitive rehabilitation comprises tasks to reinforce or reestablish previously learned patterns of behavior or to establish new compensatory mechanisms for impaired neurologic systems. Cognitive rehabilitation may be performed by a physician, psychologist, or a physical, occupational, or speech therapist.
For individuals who have cognitive deficits due to TBI who receive cognitive rehabilitation delivered by a qualified professional, the evidence includes RCTs, nonrandomized comparison studies, case series, and systematic reviews. Relevant outcomes are functional outcomes and quality of life. The cognitive rehabilitation trials have methodologic limitations and have reported mixed results, indicating there is no uniform or consistent evidence base supporting the efficacy of this technique. Systematic reviews have generally concluded that efficacy of cognitive rehabilitation is uncertain. The evidence is insufficient to determine that the technology results in an improvement in the net health outcome.
For individuals who have cognitive deficits due to dementia who receive cognitive rehabilitation delivered by a qualified professional, the evidence includes RCTs, nonrandomized comparison studies, case series, and systematic reviews. Relevant outcomes are functional outcomes and quality of life. A Cochrane systematic review focusing on outcomes related to everyday function found statistically significantly improved participant self-ratings of goal attainment related to everyday functioning both immediately following rehabilitation and after 3 to 12 months follow-up post-rehabilitation. There was less certainty regarding whether cognitive rehabilitation had a meaningful effect on quality of life. One large RCT evaluating a goal-oriented cognitive rehabilitation program reported a significantly less functional decline in 1 of 2 functional scales and lower rates of institutionalization in the cognitive rehabilitation group compared with usual care at 24 months. These results need replication. The evidence is insufficient to determine that the technology results in an improvement in the net health outcome.
For individuals who have cognitive deficits due to stroke who receive cognitive rehabilitation delivered by a qualified professional, the evidence includes RCTs and systematic reviews. Relevant outcomes are functional outcomes and quality of life. Four systematic reviews evaluating 3 separate domains of cognitive function have shown no benefit of cognitive rehabilitation or effects of clinical importance. The evidence is insufficient to determine that the technology results in an improvement in the net health outcome.
For individuals who have cognitive deficits due to MS who receive cognitive rehabilitation delivered by a qualified professional, the evidence includes RCTs and systematic reviews. Relevant outcomes are functional outcomes and quality of life. Systematic reviews of RCTs have shown no significant effects of cognitive rehabilitation on cognitive outcomes. Although numerous RCTs have investigated cognitive rehabilitation for MS, high-quality trials are lacking. The ability to draw conclusions based on the overall body of evidence is limited by the heterogeneity of patient samples, interventions, and outcome measures. Further, results of the available RCTs have been mixed, with positive studies mostly reporting short-term benefits. Evidence for clinically significant, durable improvements in cognition is currently lacking. The evidence is insufficient to determine that the technology results in an improvement in the net health outcome.
For individuals who have cognitive deficits due to post-acute sequelae of SARS-CoV-2 infection who receive cognitive rehabilitation delivered by a qualified professional, no relevant evidence was identified. Relevant outcomes are functional outcomes and quality of life. Systematic reviews have reported on the prevalence and duration of cognitive symptoms among patients with varying acute infection severity and treatment settings. Limited reports examining the outcomes of rehabilitation in patients with post-acute COVID-19 have primarily focused on physical and respiratory rehabilitation. Additionally, the natural history of cognitive deficits experienced by patients who have recovered from acute COVID-19 requires further elucidation. The evidence is insufficient to determine that the technology results in an improvement in the net health outcome.
For individuals who have cognitive deficits due to epilepsy, ASD, postencephalopathy, or cancer who receive cognitive rehabilitation delivered by a qualified professional, the evidence includes RCTs, nonrandomized comparison studies, and case series. Relevant outcomes are functional outcomes and quality of life. The quantity of studies for these conditions is much less than that for the other cognitive rehabilitation indications. Systematic reviews generally have not supported the efficacy of cognitive rehabilitation for these conditions. Relevant RCTs have had methodologic limitations, most often very short lengths of follow-up, which do not permit strong conclusions about efficacy. The evidence is insufficient to determine that the technology results in an improvement in the net health outcome.
This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records.
Cognitive rehabilitation (as a distinct and definable component of the rehabilitation process) may be considered medically necessary in the rehabilitation of individuals with cognitive impairment due to traumatic brain injury.
Cognitive rehabilitation (as a distinct and definable component of the rehabilitation process) is considered investigational for all other applications, including, but not limited to, stroke, postencephalitic or postencephalopathic individuals , autism spectrum disorder, seizure disorders, multiple sclerosis, the aging population, including individuals with Alzheimer disease, individuals with cognitive deficits due to brain tumor or previous treatment for cancer, and individuals with post-acute cognitive sequelae of SARS-CoV-2 infection.
97129, 97130
| ICD-10-CM | S06.0-S06.9x9- | Traumatic brain injury, code range |
For services to be considered medically necessary, they must be provided by a qualified licensed professional and must be prescribed by the attending physician as part of the written care plan. Additionally, there must be a potential for improvement (based on preinjury function), and patients must be able to participate actively in the program. Active participation requires sufficient cognitive function to understand and participate in the program, as well as adequate language expression and comprehension (ie, participants should not have severe aphasia). Ongoing services are considered necessary only when there is demonstrated continued objective improvement in function.
Duration and intensity of cognitive rehabilitation therapy programs vary. One approach for comprehensive cognitive rehabilitation is a 16-week outpatient program comprising 5 hours of therapy daily for 4 days each week. In another approach, cognitive group treatment occurs for three 2-hour sessions weekly and three 1-hour individual sessions (total, 9 hours weekly). Cognitive rehabilitation programs for specific deficits (eg, memory training) are less intensive and generally have 1 or 2 sessions (30 or 60 minutes) in a week for 4 to 10 weeks.
