90876 CPT® code: payer coverage and prior authorization1 of 4 payer prior-auth lists that name 90876 require prior authorization or set conditions: Molina Healthcare of Ohio.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| Molina Healthcare of Ohio | Exchange | OH | prior auth required | Oct 1, 2023 | Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01 |
90876 appears in 39 coverage policies from Aetna, Anthem, Blue Cross & Blue Shield of Mississippi, Blue Cross Blue Shield of Massachusetts, Blue Cross NC, Blue Shield of California, BlueCross BlueShield of South Carolina, Capital Blue Cross, Centene, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), Regence.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Attention Deficit/Hyperactivity Disorder (0426) EEG theta/beta power ratio, Gut microbiota profile, polygenic risk score, evaluation of kynurenine pathway | not covered | Jul 7, 2026 | payer document |
| Aetna | Biofeedback (0132) | covered if criteria are met | Jul 16, 2026 | payer document |
| Aetna | Complementary and Alternative Medicine (0388) | listed, no stance | Jun 25, 2026 | payer document |
| Aetna | Eating Disorders (0511) | not covered (range 90875-90876) | Aug 4, 2026 | payer document |
| Aetna | Eye Movement Desensitization and Reprocessing (EMDR) Therapy (0583) | listed, no stance (range 90832-90899) | Sep 18, 2026 | payer document |
| Aetna | Hyperhidrosis (0504) | not covered (range 90875-90876) | Aug 11, 2026 | payer document |
| Aetna | Tourette's Syndrome (0480) | not covered | Jul 24, 2026 | payer document |
| Anthem | Biofeedback and Neurofeedback (CG-MED-97) | covered if criteria are met | May 14, 2026 | payer document |
| Anthem | Biofeedback and Neurofeedback (CG-MED-97) | not covered | May 14, 2026 | payer document |
| Blue Cross & Blue Shield of Mississippi | Biofeedback (L.2.01.400) | unproven / investigational | payer document | |
| Blue Cross & Blue Shield of Mississippi | Biofeedback As A Treatment Of Urinary Incontinence In Adults | unproven / investigational | payer document | |
| Blue Cross & Blue Shield of Mississippi | Neurofeedback (L.2.01.441) | covered if criteria are met | payer document | |
| Blue Cross & Blue Shield of Mississippi | Temporomandibular Joint Disorder | not covered | payer document | |
| Blue Cross Blue Shield of Massachusetts | Biofeedback as a Treatment of Chronic Pain (210) | unproven / investigational | payer document | |
| Blue Cross Blue Shield of Massachusetts | Biofeedback as a Treatment of Fecal Incontinence or Constipation (308) | listed, no stance | payer document | |
| Blue Cross Blue Shield of Massachusetts | Biofeedback as a Treatment of Urinary Incontinence (173) | unproven / investigational | payer document | |
| Blue Cross Blue Shield of Massachusetts | Biofeedback for Misc Indications (187) | unproven / investigational | payer document | |
| Blue Cross Blue Shield of Massachusetts | Biofeedback for the treatment of Headache (152) | listed, no stance | payer document | |
| Blue Cross NC | Quantitative Electroencephalography | listed, no stance | Jun 1, 2026 | payer document |
| Blue Shield of California | Biofeedback as a Treatment of Chronic Pain (2.01.30) | listed, no stance | payer document | |
| Blue Shield of California | Biofeedback for Miscellaneous Indications (2.01.53) | listed, no stance | payer document | |
| Blue Shield of California | | Biofeedback as a Treatment of Headache (2.01.29) | listed, no stance | payer document | |
| BlueCross BlueShield of South Carolina | Biofeedback as a Treatment of Chronic Pain (CAM 20130) | listed, no stance (range 90875-90876) | Apr 1, 2026 | payer document |
| BlueCross BlueShield of South Carolina | Biofeedback as a Treatment of Fecal Incontinence or Constipation (CAM 20164) | listed, no stance (range 90875-90876) | Oct 1, 2025 | payer document |
| BlueCross BlueShield of South Carolina | Biofeedback as a Treatment of Urinary Incontinence in Adults (CAM 20127) | listed, no stance (range 90875-90876) | Feb 1, 2026 | payer document |
| BlueCross BlueShield of South Carolina | Neurofeedback (CAM 20128) | listed, no stance (range 90875-90876) | Feb 1, 2026 | payer document |
| Capital Blue Cross | Biofeedback as a Treatment of Chronic Pain (MP 2.064) Procedure Codes | covered if criteria are met | Sep 1, 2026 | payer document |
| Capital Blue Cross | Biofeedback as a Treatment of Fecal Incontinence or Constipation (MP 2.398) Procedure Codes | covered if criteria are met | Sep 1, 2026 | payer document |
| Capital Blue Cross | Biofeedback as a Treatment of Headache (MP 2.400) Procedure Codes | covered if criteria are met | Sep 1, 2026 | payer document |
| Capital Blue Cross | Biofeedback as a Treatment of Urinary Incontinence in Adults (MP 2.399) Procedure Codes | unproven / investigational | Sep 1, 2026 | payer document |
| Capital Blue Cross | Biofeedback for Miscellaneous Indications (MP 2.401) Procedure Codes | unproven / investigational | Sep 1, 2026 | payer document |
| Capital Blue Cross | Neurofeedback (MP 2.029) Procedure Codes | unproven / investigational | Sep 1, 2026 | payer document |
| Centene | Biofeedback for Behavioral Health Disorders (CP.BH.300) | covered if criteria are met | May 1, 2025 | payer document |
| Health Care Service Corporation (BCBS IL, TX, OK, NM, MT) | Biofeedback as a Treatment of Chronic Pain (PSY301.018) | listed, no stance | Jun 15, 2025 | payer document |
| Health Care Service Corporation (BCBS IL, TX, OK, NM, MT) | Biofeedback as a Treatment of Fecal Incontinence or Constipation (PSY301.017) | listed, no stance | Apr 1, 2025 | payer document |
| Health Care Service Corporation (BCBS IL, TX, OK, NM, MT) | Biofeedback as a Treatment of Headache (PSY301.019) | listed, no stance | Jan 1, 2026 | payer document |
| Health Care Service Corporation (BCBS IL, TX, OK, NM, MT) | Biofeedback as a Treatment of Urinary Incontinence (PSY301.016) | listed, no stance | Jan 1, 2026 | payer document |
| Health Care Service Corporation (BCBS IL, TX, OK, NM, MT) | Biofeedback for Miscellaneous Indications (PSY301.007) | listed, no stance | Jan 1, 2026 | payer document |
| Regence | Biofeedback (Allied Health 32) | listed, no stance | Oct 1, 2025 | payer document |
| Regence | Neurofeedback (Medicine 65) | listed, no stance | Oct 1, 2025 | payer document |
Prior authorization required or conditional in IN, MD.
From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.