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Wade et al. (2003) evaluated whether a program of multidisciplinary rehabilitation and group support achieves sustained benefit for people with Parkinson's disease. The study was a randomized controlled crossover trial comparing 144 patients and carers who had received rehabilitation four months before assessment with those who had not. Analysis comparing patients before and six months after treatment showed worsening in disability, quality of life, and carer strain. The investigators concluded that patients with Parkinson's disease decline significantly over six months, but a short spell of multidisciplinary rehabilitation may improve mobility.
Riccio and French (2004) evaluated available empirical support regarding the efficacy of treatments for treatment of attention deficits across disorders and age levels. The search of the major databases yielded 83 studies that included treatment of attentional deficits. A review of the studies indicated that, regardless of the treatment program or population, the existing research does not provide sufficient evidence to reach any conclusions about the efficacy of programs designed to address attention deficits. Before any conclusions can be drawn, there is a need for more rigorous study of available treatment programs across age levels and disorders, with sufficient baseline and outcome data as well as control or alternative treatment conditions.
Professional Societies National Academy of Neuropsychology (NAN): In a 2002 position statement, NAN expressed support for empirically and rationally based cognitive rehabilitation techniques that are designed to improve the quality of life and functional outcomes for patients with acquired brain injury. This statement also outlined the need for more evidence-based research to define cost-effective cognitive rehabilitation interventions (NAN, 2002).
Cognitive Rehabilitation- Commercial Medical Management Guideline
References and Resources Resources Blue Cross/Blue Shield Cognitive Rehabilitation for Traumatic Brain Injury in Adults - Executive Summary. May 2008. Available at: http://www.bcbs.com/blueresources/tec/vols/23/23_03.pdf Accessed April 2009.
Bowen A, Lincoln N. Cognitive rehabilitation for spatial neglect following stroke. Cochrane
Database of Systematic Reviews 2007, Issue 2. Art. No.: CD003586. DOI:
Carney N, Chesnut R, and Maynard H.,et al. Effect of cognitive rehabilitation on outcomes for persons with traumatic brain injury: A systematic review. J Head Trauma Rehabil. 1999a;14: 277Carney N, du Coudray H, Davis-OReilly C, et al. Rehabilitation for traumatic brain injury in children and adolescents. Evidence report no. 2, supplement (Contract 290-97-0018 to Oregon Health Sciences University). Rockville, MD: Agency for Healthcare Research and Quality. September 1999b.
Available at: http://www.ncbi.nlm.nih.gov/books/bv.fcgi?call=bv.View.
ShowSection&rid=hstat1.chapter.2633. Accessed April 2009.
Chesnut RM, Carney N, Maynard H, et al. Rehabilitation for traumatic brain injury. Evidence report
no. 2 (Contract 290-97-0018 to Oregon Health Sciences University). Summary. Rockville, MD:
Agency for Healthcare Research and Quality; February 1999. Available at:
http://www.ahrq.gov/clinic/epcsums/tbisumm.htm. Accessed April 2009.
Cicerone K, Dahlberg C, Kalmar K, et al. Evidence-Based Cognitive Rehabilitation:
Recommendations for Clinical Practice. Arch Phys Med Rehabilitation. December 2000:81;1596Cicerone KD, Mott T, Azulay J, Friel JC. Community integration and satisfaction with functioning after intensive cognitive rehabilitation for traumatic brain injury. Arch Phys Med Rehabil.
Ellis D and Rader MA. Structured Sensory Stimulation. Physical Medicine and Rehabilitation: State of the art reviews. The coma emerging patient. October 1990;4(3): 465-77.
Farina E, Mantovani F, Fioravanti R, Pignatti R, Chiavari L, Imbornone E, Olivotto F, Alberoni M, Mariani C, Nemni R. Evaluating two group programmes of cognitive training in mild-to-moderate AD: is there any difference between a 'global' stimulation and a 'cognitive-specific' one?. Aging Ment Health. 2006 May;10(3):211-8.
Cognitive Rehabilitation- Commercial Medical Management Guideline Hayes, Inc. Medical Technology Directory. Cognitive Rehabilitation for Traumatic Brain Injury.
Hayes, Inc; Lansdale, PA: April 2, 2008.
Levine B, Robertson IH, Clare L, et al. Rehabilitation of executive functioning: an experimentalclinical validation of goal management training. J Int Neuropsychol Soc. 2000;6(3):299-312.
Lincoln N, Majid M, Weyman N. Cognitive rehabilitation for attention deficits following stroke.
Cochrane Database of Systematic Reviews 2000, Issue 4. Art. No.: CD002842. DOI:
Lombardi F, Taricco M, DeTanti A et al. Sensory stimulation of brain-injured individuals in coma or vegetative state: Results of a Cochrane systematic review. Clinical Rehab; 2002 Aug;16(5):464-72.
Mazaux J and Richer E. Rehabilitation after traumatic brain injury in adults. Disabil Rehabil.
Nair RD, Lincoln NB. Cognitive rehabilitation for memory deficits following stroke. Cochrane Database Syst Rev. 2007 Jul 18;(3):CD002293.
National Academy of Neuropsychology (NAN) [Web site]. Position paper. Cognitive Rehabilitation.
May 2002. Available at:
Accessed April 2009.
National Institutes of Health (NIH)Consensus Conference. Rehabilitation of persons with traumatic brain injury. NIH Consensus Development Panel on Rehabilitation of Persons With Traumatic Brain Injury. JAMA. 1999a;282:974-983.
National Institutes of Health (NIH) Consensus Conference. Rehabilitation of persons with traumatic brain injury. NIH Consensus Development Panel on Rehabilitation of Persons with Traumatic Brain Injury. JAMA. 1999b;282(10):974-983.
Neistadt M. Occupational therapy treatments for constructional deficits. Am J Occup Ther. 1992;46:
Novack T, Caldwell S and Duke L et al. Focused versus unstructured intervention for attention deficits after traumatic brain injury. J Head Trauma Rehabil. 1996;11: 52-60.
Powell J, Heslin J, Greenwood R. Community based rehabilitation after severe traumatic brain injury:
a randomised controlled trial. J Neurol Neurosurg Psychiatry. 2002;72(2):193-202.
Cognitive Rehabilitation- Commercial Medical Management Guideline Riccio CA, French CL. The status of empirical support for treatments of attention deficits. Clin Neuropsychol. 2004 Dec;18(4):528-58.
Ruff R and Niemann H. Cognitive rehabilitation versus day treatment in head-injured adults: is there an impact on emotional and psychosocial adjustment? Brain Inj. 1990;4: 339-347.
Salazar A, Warden D and Schwab K et al. Cognitive rehabilitation for traumatic brain injury. A randomized trial. JAMA. 2000;283(23): 3075-3081,3123-3124.
Sitzer DI, Twamley EW, Jeste DV. Cognitive training in Alzheimer's disease: a meta-analysis of the literature. Acta Psychiatr Scand. 2006 Aug;114(2):75-90.
Wade DT, Gage H, Owen C, Trend P, Grossmith C, Kaye J. Multidisciplinary rehabilitation for people with Parkinson's disease: a randomised controlled study. J Neurol Neurosurg Psychiatry. 2003 Feb;74(2):158-62.
Westerberg H, Jacobaeus H, Hirvikoski T, Clevberger P, Ostensson ML, Bartfai A, Klingberg T.
Computerized working memory training after stroke--a pilot study. Brain Inj. 2007 Jan;21(1):21-9.
Wilson Sl, McMillan TM. A review of the evidence for the effectivenss of sensory stimulation treatment for coma and vegetative states. Neuropsychol Rehabil 1993;3(2):149-69.
Zasler ND, Kreutzer JS, Taylor D. Coma stimulation and coma recovery: a critical review.
History/Updates Policy revised with changes to the coverage rationale. CMS information updated.
7/1/2009 Removed CPT code 97533 from the coding section. Policy 2008T0144F archived.
12/1/2008 Policy updated and reformatted. CMS updated. Coding updated to remove CPT codes 92507, 97139, 97530, 97535, 97537, 97755, 97799. Policy 2007T0144E archived.
11/1/2007 Policy updated. CMS updated. Policy 2005T0144D archived 9/27/2005 CPT code 97770 removed and HCPCS code S9056 added to Coding Section per direction from the Reimbursement Medical Policy Operations Manager.
9/15/2005 Policy update with additional discussion of coma stimulation. Policy ( 2002T0144C) archived.
Cognitive Rehabilitation- Commercial Medical Management Guideline
7/12/2004 CPT codes 92507, 97530, 97755 added to Coding Section per direction from the Reimbursement Medical Policy Operations Manager.
2/28/2003 Medicare entry - no CMS issuance.
7/25/2002 New version, Title changed (formerly Cognitive Rehabilitation for the Treatment of Traumatic Brain Injury), Coverage revised, Research updated 2/26/2002 Policy Reformatted Coding The Current Procedural Terminology (CPT) codes and HCPCS codes listed in this policy are for reference purposes only. Listing of a service code in this policy does not imply that the service described by this code is a covered or non-covered health service. Coverage is determined by the benefit document.
97532 Development of cognitive skills to improve attention, memory, problem solving, (includes compensatory training), direct (one-on-one) patient contact by the provider, each 15 minutes
S9056 Coma stimulation per diem This information is being distributed to you for personal reference. The information belongs to UnitedHealthcare and unauthorized copying, use and distribution are prohibited. This information is intended to serve only as a general reference resource regarding our Medical Policies and is not intended to address every aspect of a clinical situation. Physicians and patients should not rely on these Medical Policies in making health care decisions. Physicians and patients must exercise their independent clinical discretion and judgment in determining care. The enrollee's specific benefit documents supercede these policies and are used to make coverage determinations. These Medical Policies are believed to be current as of the date noted.
Confidential and Proprietary, © UnitedHealthcare, Inc. 2009 Cognitive Rehabilitation- Commercial Medical Management Guideline TITLE: Computed Tomographic Colonography Authorized By: Medical Management Guideline Committee
Adoption Date: 08/11/09 Revision Date:
Disclaimer This medical management guideline represents the recommendation of the PacifiCare Medical Management Guideline (MMG) committee. It is based on the MMG committee's review of the available evidence as of the date of this medical management guideline.
This medical management guideline contains clinical practice and utilization criteria to assist professionals in PacifiCare’s medical management practice when making medical necessity determinations prior to, subsequent to, or concurrent with the provisions of health care services. This medical management guideline is intended to support consistent, appropriate medical necessity determinations, but it does not replace an individualized case-by-case review and medical necessity determination for each PacifiCare member.
Member benefit coverage and limitations may vary based on the member’s benefit plan.
This information is being distributed to you for personal reference. The information belongs to UnitedHealthcare and unauthorized copying, use and distribution are prohibited. This information is intended to serve only as a general reference resource regarding our Medical Policies and is not intended to address every aspect of a clinical situation. Physicians and patients should not rely on these Medical Policies in making health care decisions. Physicians and patients must exercise their independent clinical discretion and judgment in determining care. The enrollee's specific benefit documents supersede these policies and are used to make coverage determinations. These Medical Policies are believed to be current as of the date noted.
Description After evaluating relevant benefit document language (exclusions or limitations), refer to Coverage sections of this document to determine coverage.
This policy describes the use of computed tomographic colonography (CTC), commonly referred to as virtual colonoscopy for the diagnosis of colorectal polyps, cancer, or in follow-up to Crohn's disease or diverticulitis.
Computed Tomographic Colonography - Commercial Medical Management Guideline
Coverage All reviewers must first identify member eligibility, any federal or state regulatory requirements and the plan benefit coverage prior to use of this policy.
Computed tomographic colonography is proven for the following:
• as a diagnostic tool for symptomatic patients who are unable to undergo a complete colonoscopy (such as individuals with an obstructive tumor and others who may be unable to tolerate the procedure)
• as a screening test for colon cancer
Computed tomographic colonography is unproven as a diagnostic tool for the following:
• Crohn's disease
• Diverticulitis There is insufficient evidence to support the use of computed tomographic colonography for Crohn's disease. Only 1 study was found comparing conventional colonoscopy with virtual colonoscopy in 16 patients. Widespread use of virtual colonoscopy in Crohn's disease is currently not supported due to the potential of false-negative findings. Computed tomographic colonography was compared to conventional colonoscopy in patients with symptomatic diverticular disease.
While use of CTC for diverticulitis is more promising, there was only one study available for review involving 50 patients. Further studies are needed to determine the safety and efficacy of computed tomographic colonography as a follow-up diagnostic tool for Crohn's disease or diverticulitis.