BlueCross and BlueShield of Montana Medical Policy/Codes
Chapter: Therapies
Current Effective Date: December 27, 2013
Original Effective Date: February 26, 2009
Publish Date: December 27, 2013
Revised Dates: March 1, 2010; December 11, 2013

Hypnosis is an induced state in which there is an increased amenability and responsiveness to suggestions and commands. The clinical application of hypnosis in relief of pain is directed toward controlling the pain itself and in relieving the emotional distress that the pain causes the patient.  By understanding and relieving the suffering, hypnosis allows more effective control of pain.


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.


Hypnosis may be considered medically necessary when used to control acute or chronic pain (e.g., during dressing changes for an extensive burn patient), or as an adjunct to psychotherapy.

Hypnosis is considered experimental, investigational and unproven when used for anesthesia, including but not limited to use during any stage of labor.

Note: When hypnosis is used for weight management or smoking cessation, refer to specific contract language.


There are several advantages in the use of psychological pain relief over somatic techniques in the management of acute and chronic pain.  Hypnosis can control pain without unpleasant side effects, and can create life-enhancing attitudes in the patient.  Hypnotic techniques generally include:

  • blocking awareness of pain,
  • substituting another feeling (such as pressure) for the pain,
  • moving the pain to a smaller less significant body part, or
  • changing the meaning of the pain so it is less important.

A MEDLINE search January 2002 through June 2006 confirmed that hypnosis continues to be recognized as a successful adjutant to pain and anxiety relief.  Additional studies continue to recommend that psychotherapy be included with hypnosis.

A current literature search revealed a lack of clinical data demonstrating that the use of hypnosis for anesthesia is associated with an improvement in final health outcomes

2013 Update

A search of peer reviewed literature through July 2013 identified no new clinical trial publications or any additional information that would change the coverage position of this medical policy.


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
ICD-10 Codes


Procedural Codes: 90880
  1. Holroyd, J.  Hypnosis treatment of clinical pain:  understanding why hypnosis is useful.  International Journal of Clinical and Experimental Hypnosis (1996 January) 44(1): 33-51.
  2. Patterson, D.R., Goldberg, M.L., et al.  Hypnosis in the treatment of patients with severe burns.  American Journal of Clinical Hypnosis (1996 January) 38(3): pages 200-212; discussion page 213.
  3. Wallace, B., Allen, P.A., et al.  Hypnotic susceptibility, imaging ability, and anagram-solving activity.  International Journal of Clinical and Experimental Hypnosis (1996 October) 44(4): 324-37.
  4. Martin, D.J., Lynn, S.J.  The hypnotic simulation index:  successful discrimination of real versus simulating participants.  International Journal of Clinical and Experimental Hypnosis (1996 October) 44(4): 338-53.
  5. Lynch, D.F., and D.F. Lynch, Jr.  Empowering the patient:  hypnosis in the management of cancer, surgical diseases and chronic pain.  American Journal of Clinical Hypnosis (1999 October) 42(2): 122-30.
  6. Benhaiem, J.M., Attal, N., et al.  Local and remote effects of hypnotic suggestions of analgesia. Pain (2001 January) 89(2-3):167-73
  7. Wright, B.R., and P.D. Drummond.  The effect of Rapid Induction Analgesia on subjective pain ratings and pain tolerance.  International Journal of Clinical and Experimental Hypnosis (2001 April) 49(2):109-22.
  8. Lu,D.P., Lu,G.P., et al.  Acupuncture and clinical hypnosis for facial and head and neck pain: a single crossover comparison.  American Journal Clinical Hypnosis (2001 October) 44(2):141-8.
  9. Frenay, M.C., Faymonville, M.E., et al.  Psychological approaches during dressing changes of burned patients: a prospective randomized study comparing hypnosis against stress reducing strategy. Burns (2001 December) 27(8):793-9.
  10. Ray, W.J., Keil, A., et al.  High resolution EEG indicators for pain response in relation to hypnotic susceptibility and suggestion.  Biological Psychology (2002) 60(1):17-36.
  11. Montgomery, G.H., David, D., et al.  The effectiveness of adjunctive hypnosis with surgical patients: a meta-analysis.  Anesthesia and Analgesia (2002 June) 94(6): 1639-45.
  12. Hermes, D., Trubger, D., et al.  Perioperative use of medical hypnosis.  Therapy options for anasthesists and surgeons.  Anaesthesist (2004 April) 53(4): 326-33.
  13. Araoz, D.  Defining hypnosis.  American Journal of Clinical Hypnosis (2005 January) 48(2-3): 123-6.
  14. Butler, L.D., Symons, B.K., et al.  Hypnosis reduces distress and duration of an invasive medical procedure for children.  Pediatrics (2005 January) 115(1): e77-85.
  15. Raij, T.T., Numminen, J., et al.  Brain correlates of subjective reality of physically and psychologically induced pain.  Proceedings of the National Academy of Sciences of the United States (2005 February 8) 102(6): 2147-51.
  16. Milling, L.S., Kirsch, I., et al.  The effects of hypnotic and nonhypnotic imaginative suggestion on pain.  Annals of Behavioral Medicine (2005 April) 29(2): 116-27.
  17. Jensen, M.P., and D.R. Patterson.  Control conditions in hypnotic-analgesia clinical trials: challenges and recommendations.  International Journal of Clinical Hypnosis (2005 April) 53(2): 170-97.
  18. Stewart, J.H.  Hypnosis in contemporary medicine.  Mayo Clinic Proceedings (2005 April) 80(4): 511-24.
  19. Jenson, M.P., Hanley, M.A., et al.  Hypnotic analgesia for chronic pain in persons with disabilities: a case series.  International Journal of Clinical Hypnosis (2005 April) 53(2): 198-228. 
  20. Rainville, P., Bao, Q.V., et al.  Pain-related emotions modulate experimental pain perception and autonomic responses.  Pain (2005 December 5) 118(3): 306-18.
  21. Schupp, C.J., Berbaum, M., et al.  Pain and anxiety during interventional radiologic procedures:  effect of patients’ state of anxiety at baseline and modulation by nonpharmacologic analgesia adjuncts.  Journal of Vascular and Interventional Radiology (2005 December) 16(12): 1585-92.
  22. Richardson, J., Smith, J.E., et al.  Hypnosis for procedure-related pain and distress in pediatric cancer patients:  a systematic review of effectiveness and methodology related to hypnosis interventions.  Journal of Pain and Symptom Management (2006 January) 31(1): 70-84.
  23. Jensen, M., and E. R. Patterson.  Hypnotic treatment of chronic pain.  Journal of Behavioral Medicine (2006 February) 29(1): 95-124.
  24. Patterson, D.R., Wiechman, S.A., et al.  Hypnosis delivered through immersive virtual reality for burn pain:  A clinical case series.  International Journal of Clinical and Experimental Hypnosis (2006 April) 54(2): 130-42.
  25. Milling, L.S., Reardon, J.M., et al.  Mediation and moderation of psychological pain treatments: response expectations and hypnotic suggestibility.  Journal of Consulting and Clinical Psychology (2006 April) 74(2): 253-62.
  26. Liossi, C., White, P., et al.  Randomized clinical trial of local anesthetic versus a combination of local anesthetic with self-hypnosis in the management of pediatric procedure-related pain.  Health Psychology (2006 May) 25(3): 307-15.
  27. Osborne, T.L., Raiche, K.A., et al.  Psychologic interventions for chronic pain.  Physchologic Medicine Rehabilitation Clinics of North America (2006 May) 17(2): 415-33.
  28. Hypnosis-Archived. Chicago, Illinois: Blue Cross Blue Shield Association Medical Policy Reference Manual (2003 January) Medicine 2.01.06.
December 2013  Policy formatting and language revised.  Policy statement unchanged.
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