BlueCross and BlueShield of Montana Medical Policy/Codes
Cognitive Rehabilitation
Chapter: Therapies
Current Effective Date: June 01, 2013
Original Effective Date: August 15, 1998
Publish Date: June 01, 2013
Revised Dates: October 15, 2003; June 6, 2006; October. 11, 2006; February 15, 2007; November 7, 2008; March 1, 2010; April 9, 2012; April 3, 2013
Description

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 consists of tasks designed to reinforce or re-establish previously learned patterns of behavior or to establish new compensatory mechanisms for impaired neurological systems.  Cognitive rehabilitation may be performed by a physician, psychologist, or a physical, occupational, or speech therapist.

Cognitive rehabilitation must be distinguished from occupational therapy; occupational therapy describes rehabilitation that is directed at specific environments (i.e., home or work).  In contrast, cognitive rehabilitation consists of tasks designed to develop the memory, language, and reasoning skills that can then be applied to specific environments, as described by the occupational therapy codes.

Duration and intensity of cognitive rehabilitation therapy programs vary.  One approach for comprehensive cognitive rehabilitation is a 16-week outpatient program consisting of five hours of therapy a day, four days a week.  In this approach, cognitive group treatment occurs for three two-hour sessions each week and three one-hour individual sessions (total of nine hours per week).  Cognitive rehabilitation programs for specific defects, e.g., memory training, are less intensive and generally have one or two sessions (30 or 60 minutes) per week for four to ten weeks.

NOTE: Sensory integration therapy is addressed separately.

Policy

Each benefit plan, summary plan description or contract defines which services are covered, which services are excluded, and which services are subject to dollar caps or other limitations, conditions or exclusions. Members and their providers have the responsibility for consulting the member's benefit plan, summary plan description or contract to determine if there are any exclusions or other benefit limitations applicable to this service or supply.  If there is a discrepancy between a Medical Policy and a member's benefit plan, summary plan description or contract, the benefit plan, summary plan description or contract will govern.

Medically Necessary

BCBSMT may consider cognitive rehabilitation (as a distinct and definable component of the rehabilitation process) medically necessary in the rehabilitation of patients with traumatic brain injury under the following circumstances:

  • Services are prescribed by the attending physician as part of a written care plan;
  • Prescribed services are provided by a qualified licensed professional;
  • There is a potential for improvement based on pre-injury function;
  • Patients have sufficient cognitive function to understand and participate in the program, as well as adequate language expression and comprehension, (i.e., participants should not have severe aphasia).

NOTE:  Ongoing services may be considered medically necessary only when there is demonstrated continued objective improvement in function.

Investigational 

BCBSMT considers cognitive rehabilitation (as a distinct and definable component of the rehabilitation process) experimental, investigational and unproven for all other applications, including, but not limited to:

  • Stroke;
  • Post-encephalitic or post-encephalopathy patients;
  • The aging population; and
  • Alzheimer’s patients.     

Rationale

This policy was originally based on a 1997 Blue Cross Blue Shield Association (BCBSA) Technology Evaluation Center (TEC) Assessment.  The Assessment addressed a broad range of patient indications resulting from neurological insults, including traumatic brain injury, stroke, post-encephalopathy, and aging (including Alzheimer’s disease).  Eighteen controlled trials were reviewed, primarily focusing on stroke and traumatic brain injury.  No controlled trials were available that specifically addressed the remaining patient indications.  No clear answer regarding the efficacy of cognitive rehabilitation emerged from the Assessment.  The evidence was conflicting either because of study design, low power to detect differences, or variation in treatment.  The Assessment concluded that data were inadequate in the published peer-reviewed literature to validate the effectiveness of cognitive rehabilitation as either an isolated component or one component of a multimodal rehabilitation program.

Traumatic Brain Injury

A 2008 BCBSA TEC Assessment was completed on cognitive rehabilitation in traumatic brain injury.  The objective of this Assessment was to determine whether there is adequate evidence to demonstrate that cognitive rehabilitation results in improved health outcomes.  For the purposes of this Assessment, cognitive test performance is not considered a health outcome.  Results of instruments assessing daily functioning or quality of life are considered health outcomes.

For the Assessment’s main evidence review, randomized, controlled trials of cognitive rehabilitation were selected.  A nonrandomized study of a comprehensive holistic program of cognitive rehabilitation was also included.  Two studies of comprehensive holistic cognitive rehabilitation were reviewed.  The one randomized study found no differences in the outcomes of return to work, fitness for military duty, quality of life, and measures of cognitive and psychiatric function at one year.  Rates of returning to work were greater than 90% for both the intervention and control groups, raising the question whether the subjects included in the study were not severely injured enough to be able to demonstrate an effect of rehabilitation.  The other study of comprehensive rehabilitation was nonrandomized.  The intervention group showed greater improvements in functioning as assessed by a questionnaire that evaluated community integration, home integration, and productivity assessed on completion of the intervention. However, there were many differences in baseline characteristics between intervention and control groups, particularly regarding the time since injury.  Patients were not followed up beyond completion of the intervention program.

Eleven randomized, controlled trials of cognitive rehabilitation for specific cognitive defects showed inconsistent support for cognitive rehabilitation.  Out of the 11 studies, eight reported on health outcomes.  Three of the studies showed statistically significant differences between intervention groups and control groups on one outcome.  However, two of the studies were extremely small.  The findings were not consistent across other outcomes measured in the studies, and in one study, significant findings after the intervention were no longer present at six months of follow-up.  All 11 studies also reported outcomes of various cognitive tests.  These were not considered to be valid outcomes for the purposes of assessing health benefit.  Evaluation of these cognitive test outcomes is plagued by numerous methodological problems, such as small sample size, lack of long-term follow-up, minimal interventions, and multiple outcomes.  Seven of the studies reported at least one outcome showing that cognitive rehabilitation was associated with better performance on a specific cognitive test.  Of these positive studies, two of them had no follow-up beyond the time of treatment, and two had sample sizes smaller than 20.  In only one study was there consistency across several cognitive test scores showing better performance with cognitive rehabilitation.

In summary, the randomized trial literature of cognitive rehabilitation does not show strong evidence for efficacy in the treatment of traumatic brain injury.  Many of the clinical trials of specific cognitive rehabilitation interventions evaluated cognitive tests rather than health outcomes.  Demonstration of the effectiveness of cognitive rehabilitation, either as an integrated holistic program, or as a separable component that treats a specific cognitive defect, requires prospective randomized designs that employ validated measures of health outcomes.

2009 Update

A comprehensive program of neuropsychologic rehabilitation was compared to standard rehabilitation in a randomized trial published in 2008.  This study was intended to be a more rigorous evaluation of the nonrandomized study reviewed in the 2008 TEC Assessment.  Sixty-eight patients were randomized to the two intervention groups.  The principal outcomes measured were the Community Integration Questionnaire (CIQ) and the Perceived Quality of Life scale (PQOL).  Effectiveness of the intervention was evaluated by an interaction between intervention and pre- to post-treatment.  Such an interaction was significant for the CIQ (p=0.042) and the PQOL (p=0.049), but not for any of the secondary neuropsychologic outcomes.  It should be noted that there was a much smaller increment of improvement in the CIQ (from 11.2 to 12.9) then was observed in the prior nonrandomized trial (11.6 to 16.1).  The proportion of patients having a clinically significant improvement in CIQ (4.2 points) is not reported, but is likely to be smaller than the 52% reported in the prior non-randomized study. Follow-up assessments were also done at six months after treatment, but these were not subjected to formal statistical analysis.  It appears that the standard treatment group had further improvements in the CIQ such that their mean follow-up CIQ score is very similar to the intervention group (12.9 versus 13.2) and likely to be nonsignificant.  For the PQOL, it appears that the differences observed at the end of treatment were maintained or magnified somewhat by six months.

This randomized trial, thus, has mixed findings of efficacy of comprehensive neuropsychologic rehabilitation for traumatic brain injury.

Dementia, including Alzheimer’s Disease

The use of cognitive training or rehabilitation in Alzheimer’s disease and vascular dementia was evaluated in a 2003 Cochrane review.  It found six randomized, controlled trials on cognitive training that met study selection criteria, none of which reported any statistically significant between-group differences on any outcomes.  Limitations of the data were discussed in a 2006 meta-analysis on cognitive training in Alzheimer’s disease.  One study reported on patients that had not yet developed dementia.  A study of 2,832 seniors living independently with good functional and cognitive status were randomized to one of three training groups (memory, reasoning, speed of processing) or a no-contact control group.  While selected cognitive functioning measures showed immediate improvements, no significant improvements were found on everyday functioning measures at two years.  A controlled study reported on 25 mildly impaired patients on cholinesterase inhibitors.  Patients were assigned to either cognitive rehabilitation or equivalent therapist contact in a mental stimulation program.  Beneficial effects were observed for cognitive rehabilitation on tasks that duplicated those used in training, although generalized functional improvements were not reported.  Moreover, the differences between the two interventions are not completely clear in that both used methodologies considered cognitive rehabilitation.  An additional randomized study of 54 patients evaluated the combined effect of a cognitive-communication therapy plus an acetylcholinesterase inhibitor as compared to drug treatment alone.  A positive effect for the drug plus cognitive rehabilitation group was found in the areas of discourse abilities, functional abilities, emotional symptoms, and overall global performance.  Beneficial effects were reported up to 10 months after active intervention.  While the available evidence on cognitive rehabilitation for Alzheimer’s disease and related dementias is inadequate to permit conclusions, this last study provides encouraging evidence.  Additional collaborative data are needed to form conclusions about the effectiveness of a combined treatment of cognitive rehabilitation and acetylcholinesterase inhibitors in patients with Alzheimer’s disease.

A randomized trial not reviewed in prior policy updates was published in 2003 by Spector et al.  One-hundred fifteen subjects were randomized to receive a cognitive stimulation program or to a control group.  The intervention program ran for seven weeks, and patients were only evaluated at this time point.  The treatment group had significantly higher scores on the principal outcome, the mini-mental status exam (MMSE), with a group difference of 1.14 points.  Differences were also significant for the secondary outcomes, a quality-of-life scare for Alzheimer’s disease and an Alzheimer’s disease assessment scale.  The study did not assess any outcomes beyond the seven-week period of treatment, and the authors speculate that the intervention would need to be continued on a regular basis beyond seven weeks.  The results of this trial are not definitive in determining whether cognitive rehabilitation therapy is effective among patients with dementia.

Post-encephalopathy

Recent reports on cognitive rehabilitation and encephalopathy were limited to two small, uncontrolled series.  While both series reported favorable results with rehabilitation, the data are inadequate to change the conclusions of the earlier TEC Assessment. 

Stroke

The effectiveness of cognitive rehabilitation for stroke was assessed in three Cochrane reviews published in 2002 that separately evaluated memory deficits, attention deficits, and spatial neglect.

  • Controlled studies investigating the effectiveness of cognitive rehabilitation in improving memory deficits due to stroke were limited to a single trial of 12 patients.  Outcomes showed that memory strategy training had no significant effect on memory impairment or subjective memory complaints, although the study was underpowered to detect differences.
  • Attention deficits following stroke were evaluated in two controlled trials involving 56 patients.  The review concluded that there is some indication that training improves alertness and sustained attention but no evidence to support or refute the use of cognitive rehabilitation for attention deficits to improve functional independence after stroke.
  • The Cochrane review of cognitive rehabilitation for spatial neglect included 15 studies involving 400 subjects.  Reported outcome measures varied widely between studies.  The reviewers concluded that there is some evidence that cognitive rehabilitation for spatial neglect improves performance on some impairment tests, but its effect on disability is unclear.  Further well-designed randomized controlled trials are warranted as well as basic research to develop valid outcome measures.

A second review on the rehabilitative management of post-stroke visuospatial inattention also concluded that the long-term impact of visual scanning and perceptual retraining techniques on overall recovery and functional outcome was unclear.  A 2007-updated Cochrane review on cognitive rehabilitation for spatial neglect following stroke concluded that there is insufficient evidence to support or refute the effectiveness of several types of neglect-specific approaches to reducing disability and improving independence following stroke.

A 2007 update to a prior Cochrane review on memory deficits found only two studies that met selection criteria.  The studies found no significant effect of cognitive rehabilitation for memory deficits in stroke patients.  Other recent controlled trials evaluating cognitive rehabilitation for stroke were not found.

2012 Update

Kurz et al. published an randomly controlled trial (RCT) in 2011 for patients with Alzheimer’s disease and early dementia.  The population consisted of 201 patients with clinical evidence and dementia and the mini-mental status exam (MMSE) score of at least 21/30 that were randomized to a 12-week cognitive rehabilitation program.  There were baseline imbalances among the groups, with the intervention group having a lower mean age and higher scores on measures of functional status and quality of life.  Outcomes were assessed at three months and nine months following intervention and included a range of measures of functional status, quality of life, cognition, and caregiver burden.  There were no between group differences on any of the outcome measures.  There were also no group differences on subgroup analyses by age, gender, educational level, or baseline cognitive ability, except that depression scores improved significantly for females, but not males, in the intervention group.

For patients with traumatic brain injury, there are numerous RCTs evaluating the efficacy of cognitive rehabilitation.  However, these trials have methodologic limitations and report mixed results, indicating that there is not a uniform or consistent evidence base supporting the efficacy of this technique.  Based on review of the published trials, together with the clinical input, and consideration of the limited alternative treatments, use of cognitive rehabilitation as a distinct and definable component of the rehabilitation process may be considered medically necessary as part of the treatment of those with traumatic brain injury.

For other indications, the evidence on cognitive rehabilitation is insufficient to permit conclusions, and the clinical input was not uniform in favor of cognitive rehab.  Therefore, use of cognitive impairment in disease states other than traumatic brain injury is considered experimental, investigational and unproven.

The Institute of Medicine published a report in October 2011 titled “Cognitive Rehabilitation Therapy for Traumatic Brain Injury” that included a comprehensive review of the literature and recommendations.  The report concluded that … “current evidence provides limited support for the efficacy of CRT interventions.  The evidence varies in both the quality and volume of studies and therefore is not yet sufficient to develop definitive guidelines for health professionals on how to apply CRT in practice.”  The report recommended that standardization of clinical variables, intervention components, and outcome measures was necessary in order to improve the evidence base for this treatment.  They also recommended that future studies are needed that have larger sample sizes and include a more comprehensive set of clinical variables and outcome measures.

The Veteran Affairs (VA)/Department of Veterans Affairs, Department of Defense (DoD) published guidelines on the treatment of concussion/mild traumatic brain injury (TBI) in 2009.  These guidelines address cognitive rehab in the setting of persistent symptoms.  The guidelines state:

  • Individuals who present with memory, attention, and/or executive function problems which did not respond to initial treatment (e.g., reassurance, sleep education, or pain management) may be considered for referral to cognitive rehabilitation therapists with expertise in TBI rehabilitation (e.g., speech and language pathology, neuropsychology, or occupational therapy) for compensatory training [Strength of Recommendation = C]; and/or instruction and practice on use of external memory aids such as a personal digital assistant (PDA) [Strength of Recommendation = C].

Based on review of the published literature and clinical information through January 2012, the use of cognitive rehabilitation as a distinct and definable component of the rehabilitation process may be considered medically necessary as part of the treatment of those with traumatic brain injury.  Use of cognitive impairment in other disease states is considered experimental, investigational and unproven.

Coding

Disclaimer for coding information on Medical Policies          

Procedure and diagnosis codes on Medical Policy documents are included only as a general reference tool for each policy.  They may not be all-inclusive.           

The presence or absence of procedure, service, supply, device or diagnosis codes in a Medical Policy document has no relevance for determination of benefit coverage for members or reimbursement for providers.  Only the written coverage position in a medical policy should be used for such determinations.           

Benefit coverage determinations based on written Medical Policy coverage positions must include review of the member’s benefit contract or Summary Plan Description (SPD) for defined coverage vs. non-coverage, benefit exclusions, and benefit limitations such as dollar or duration caps. 

ICD-9 Codes

93.83, 93.89, 294.10, 294.11, 294.8, 294.9, 326, 330.0, 330.1, 330.2, 330.3, 330.8, 330.9, 331.0, 331.11, 331.19, 331.2, 331.3, 331.4, 331.5, 331.6, 331.7, 331.82, 331.89, 332.0, 332.1, 333.4, 333.5, 334.0, 334.2, 334.3, 334.4, 334.8, 335.20, 335.21, 348.1, 430, 431, 432.0, 432.1, 432.9, 436, 438.0, 438.10, 438.11, 438.12, 905.0, 905.1, 906.0, 906.4, 906.5, 907.0, 907.1, 907.2, 909.0, 909.1, 909.2, 909.3, 909.4, 909.5, 997.01, 997.02, V40.0, V40.1, V48.4, V48.5, V57.1,V57.22

ICD-10 Codes
F02.80, F02.81, F06.0 - F06.8, F81.9, G09, E75.23 - E75.29, E75.00 - E75.4, E75.6, F84.2, G10, G11.1, G11.3, G11.8, G12.21 - G12.21, G13.8, G93.1-G94, G97.2 - G97.821, I60.00 - I60.9, I61.0 - I61.9 , I62.00 - I62.03, I62.1, I62.9, I67.8, I69.0, I69.01 - I69.91, I69.920, I69.921, L59.9, T66.XXXS, Z87.898
Procedural Codes: 97532
References
  1. Cognitive Rehabilitation.  Chicago, Illinois: Blue Cross Blue Shield Association – Technology Evaluation Center Assessment Program (1997 June) 12(6):1-41.
  2. Schmidt, J.G., Drew-Cates, J., et al.  Anoxic encephalopathy: outcome after inpatient rehabilitation.  Journal of Neurologic Rehabilitation (1997) 11(3):189-95.
  3. Lindgren, M., Hagstadius, S., et al.  Neuropsychological rehabilitation of patients with organic solvent-induced chronic toxic encephalopathy.  A pilot study.  Neuropsychological Rehabilitation (1997 January 1).
  4. Lincoln, N.B., Majid, M.J., et al.  Cognitive rehabilitation for attention deficits following stroke. Cochrane Database System Review (2000) (4):CD002842.
  5. Salazar, A.M., Warden, D.L., et al.  Cognitive rehabilitation for traumatic brain injury: a randomized trial.  JAMA (2000) 283:3075-81.
  6. Cicerone, K.D., Dahlberg, C., et al.  Evidence-based cognitive rehabilitation: recommendations for clinical practice.  Archives of Physical Medicine and Rehabilitation (2000) 81(12):1596-615.
  7. Diamond, P.T.  Rehabilitative management of post-stroke visuospatial inattention.  Disability and Rehabilitation (2001 July 10) 23(10):407-12.
  8. Bowen, A., Lincoln, N.B., et al.  Cognitive rehabilitation for spatial neglect following stroke.  Cochrane Database System Review (2002) (2).
  9. Rapp, S., Brenes, G., et al.  Memory enhancement training for older adults with mild cognitive impairment: a preliminary study.  Aging Mental Health (2002 February) 6(1):5-11.
  10. McMillan, T., Robertson, I.H., et al.  Brief mindfulness training for attention problems after traumatic brain injury: A randomized control treatment trial.  Neuropsychological Rehabilitation (2002 March 1) 12(2):117-25.
  11. Kaschel, R., Della Sala, S., et al.  Imagery mnemonics for the rehabilitation of memory:  A randomized group controlled trial.  Neuropsychological Rehabilitation (2002 March 1) 12(2):127-53. 
  12. Majid, M.J., Lincoln, N.B., et al.  Cognitive rehabilitation for memory deficits following stroke. Cochrane Database System Review (2002) (1).
  13. Lincoln, N.B., Majid, M.J., et al.  Cognitive rehabilitation for attention deficits following stroke. Cochrane Database System Review (2002) (1).
  14. Bowen, A., Lincoln, N.B., et al.  Cognitive rehabilitation for spatial neglect following stroke. Cochrane Database System Review (2002) (3):CD002293.
  15. Ball, K., Berch, D.B., et al.  Effects of cognitive training interventions with older adults: a randomized controlled trial.  Journal of the American Medical Association (2002 November 13) 288(18):2271-81.
  16. Cognitive Rehabilitation for Traumatic Brain Injury in Adults.  Chicago, Illinois: Blue Cross Blue Shield Association – Technology Evaluation Center Assessment Program (2002 December) 17(20):1-25.
  17. National Academy of Neuropsychology (NAN).  Position paper. Cognitive Rehabilitation.  (2002 May 2002).
  18. http://199.73.36.206/NAN/Files/PAIC/PDFs/NANPositionCogRehab.pdf .
  19. Ball, K., Berch, D.B., et al.  Effects of cognitive training interventions with older adults: a randomized controlled trial. JAMA (2002) 288(18):2271-81.
  20. Powell, J., Heslin, J., et al.  Community based rehabilitation after severe traumatic brain injury:  A randomized controlled trial. J Neurol Neurosurg Psychiatry (2002) 72(2):193-202.
  21. Woods, C.L., Cook, M., et al.  Cognitive rehabilitation and cognitive training for early-stage Alzheimer’s disease and vascular dementia.  Cochrane Database System Review (2003) (4).
  22. Cahn-Weiner, D.A., Malloy, P.F., et al.  Results of a randomized placebo-controlled study of memory training for mildly impaired Alzheimer’s disease patients.  Applied Neuropsychology (2003) 10(4):215-23.
  23. Rath, J.F., Dvorah, S., et al.  Group treatment of problem-solving deficits in outpatients with traumatic brain injury: A randomized outcome study.  Neuropsychological Rehabilitation (2003 September) 13(4):461-88.
  24. Spector, A., Thorgrimsen, L., et al.  Efficacy of an evidence-based cognitive stimulation therapy programme for people with dementia: randomised controlled trial.  Br J Psychiatry (2003) 183(3):248-54.
  25. Loewenstein, D.A., Acevedo, A., et al.  Cognitive rehabilitation of mildly impaired Alzheimer disease patients on cholinesterase inhibitors.  American Journal of Geriatric Psychiatry (2004) 12(4):395-402.
  26. Chapman, S.B., Weiner, M.F., et al.  Effects of cognitive-communication stimulation for Alzheimer’s disease patients treated with donepezil.  Journal of Speech Language and Hearing Research (2004) 47(5):1149-63.
  27. Tam, S.F., Man, W.K.  Evaluating computer-assisted memory retraining programmes for people with post-head injury amnesia.  Brain Injury (2004 May) 18(5):461-70.
  28. Cicerone, K.D., Mott, T., et al.  Community integration and satisfaction with functioning after intensive cognitive rehabilitation for traumatic brain injury.  Archives of Physical Medicine and Rehabilitation (2004 June) 85(6):943-50.
  29. Tiersky, L.A., Anselmi, V., et al.  A trial of neuropsychologic rehabilitation in mild-spectrum traumatic brain injury.  Archives of Physical Medicine Rehabilitation (2005) 86(8):1565-74.
  30. Constantinidou, F., Thomas, R.D., et al.  Effects of categorization training in patients with TBI during post acute rehabilitation: preliminary findings.  Journal of Head Trauma Rehabilitation (2005) 20(2):143-57.
  31. National Institute of Neurological Disorders and Stroke.  Cognitive Rehabilitation Interventions: Moving from Bench to Bedside.  (2005 August)   accessed 2012 January 6.  Available at:  http://www.ninds.nih.gov .
  32. Hooft, I.V., Andersson, K., et al.  Beneficial effect from a cognitive training programme on children with acquired brain injuries demonstrated in a controlled study.  Brain Injury (2005) 19(7):511-8.
  33. Limond, J, and R. Leeke.  Practitioner review: cognitive rehabilitation for children with acquired brain injury.  Journal of Child Psychology and Psychiatry (2005) 46(4):339-52.
  34. Cicerone, K.D., Dahlberg, C., et al.  Evidence-based cognitive rehabilitation: updated review of the literature from 1998 through 2002.  Archives of Physical Medicine and Rehabilitation (2005) 86(8):1681-92.
  35. Sitzer, D.I, Twamley, E.J., et al.  Cognitive training in Alzheimer’s disease: A meta-analysis of the literature. Acta Psychiatrica Scandinavica (2006 August) 114(2):75-90.
  36. Hewitt, J., Evans, J.J., et al.  Theory driven rehabilitation of executive functioning: Improving planning skills in people with traumatic brain injury through the use of an autobiographical episodic memory cueing procedure.  Neuropsychologia (2006) 44:1468-74.
  37. Bowen, A., and N.B. Lincoln.  Cognitive rehabilitation for special neglect following stroke.  Cochrane Database System Review (2007) (2):CD003586.
  38. Cognitive Rehabilitation.  Chicago, Illinois: Blue Cross Blue Shield Association Medical Policy Reference Manual (2006 December) Therapy 8.03.10.
  39. Nair, R.D., and N.B. Lincoln.  Cognitive rehabilitation for memory deficits following stroke. Cochrane Database Syst Rev (2007) (3):CD002293.
  40. Cognitive Rehabilitation for Traumatic Brain Injury in Adults.  Chicago, Illinois: Blue Cross Blue Shield Association – Technology Evaluation Center Assessment Program (2008 May) 23 (3):1-27.
  41. Cicerone, K.D., Mott, T., et al.  A randomized controlled trial of holistic neuropsychologic rehabilitation after traumatic brain injury.  Arch Phys Med Rehabil (2008) 89(12):2239-49.
  42. Department of Veterans Affairs, Department of Defense. VA/DoD clinical practice guideline for management of concussion/mild traumatic brain injury. Washington (DC): Department of Veteran Affairs, Department of Defense (2009).
  43. Institute of Medicine, National Academies Press.  Cognitive rehabilitation therapy for traumatic brain injury. (2011 October)  Available online: http://iom.edu/Reports/2011/Cognitive-Rehabilitation-Therapy-for-Traumatic-Brain-Injury-Evaluating-the-Evidence.aspx  accessed January 2012.
  44. Kurz, A., Thone-Otto, A., et al.  CORDIAL: Cognitive rehabilitation and cognitive-behavioral treatment for early dementia in Alzheimer disease.  Alzheimer Dis Assoc Disord (2011) [Epub ahead of print].
  45. Cognitive Rehabilitation.  Chicago, Illinois: Blue Cross Blue Shield Association Medical Policy Reference Manual (2012 February) Therapy 8.03.10.
History
April 2012  Policy updated with literature review. Rationale rewritten, references 13, 20, 21 added. No change to policy statement; Name changed to Cognitive Rehab from Cognitive Rehab/Therapy, Outpatient.
April 2013 Policy formatting and language revised.  Policy statement unchanged.
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Cognitive Rehabilitation