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Clinical Guidelines & Insurance Information

Insurance Information

AETNA

Aetna's Clinical Policy Bulletin states: “Aetna considers eye movement desensitization and reprocessing (EMDR) therapy medically necessary for the treatment of post-traumatic stress disorder (PTSD).”

Blue Cross Blue Shield

Blue Cross Blue Shield states in its September-October 2011 BCN Provider News that EMDR "is an established therapy for adult onset post traumatic stress disorder and may be a covered service for BCN members when indicated."

Blue Cross Blue Shield of Michigan approved EMDR (effective 9/1//11) as a treatment for adult onset post traumatic stress disorder (Code 90806). (The Record, September, 2011).

Blue Cross Blue Shield of North Carolina does not review EMDR for medical necessity; EMDR is not a listed exclusion in Ocotober 2010 policy (p. 171).  Posted 8/111

Blue Cross Blue Shield of Texas works with the Behavioral Health vendor, Magellan Behavioral Health, Inc.TM, which adopted the American Psychiatric Association clinical practice guidelines.

CIGNA Behavioral Health

CIGNA follows the American Psychiatric Association (APA) Guidelines for the treatment of Acute Stress Disorder and Posttraumatic Stress Disorder. These guidelines accept EMDR for treatment. (CIGNABehavioral.com - Practice Guidelines for Behavioral Health Practitioners).

Magellan Health Services Approves EMDR

Magellan’s Clinical Practice Guideline dated February 21, 2006 states that “EMDR has been found to be about as effective as other modalities for reducing symptoms of PTSD…” It also says that “EMDR may provide relief earlier than other modalities; and may be tolerated better than ET (Exposure Therapy) by some patients.” Magellan follows the APA Guidelines. Updated 5/9/06

TRICARE

TRICARE Management Activity, the U.S. Department of Defense military health system, covers EMDR for the treatment of PTSD in adults. TRICARE changed its psychotherapy treatment policies to cover EMDR on November 3, 2010 with an effective date retroactive to April 16, 2007. EMDRIA began its efforts to gain TRICARE in 2005.

United Behavioral Health (UBH)

UBH has published its Best Practice Guidelines 2009 which for the treatment of PTSD refer to the American Psychiatric Association (APA) Guidelines. UnitedHealth Group, through its affiliate UnitedHealth Military & Veteran's Services LLC (UMVS), is contracted with the Department of Defense to provide Managed Care Support Services in the TRICARE SOUTH Region effective April 1, 2011. This involves the following states: AL, AR, GA, KY (Fort Campbell only), LA, MS, OK, SC, TN, TX (excluding El Paso) and FL. Updated 6/3/10

Wellmark BlueCross Blue Shield of Iowa

Wellmark's Behavioral Health Guide (updated October 2010) "allows benefits for up to 10 one hour-sessions of EMDR for the treatment of post tramatic stress disorder (PTSD), provided the services are medically necessary. Services for EMDR therapy are considered individual psychotherapy and should be billed using procedure codes 90804 – 90807." Updated 2/2011

This information above is what has been obtained by EMDRIA. Please send any insurance coverage updates to Mark G. Doherty.

Clinical Guidelines

APA Guidelines

The American Psychiatric Association has released Practice Guideline for the Treatment of Patients with Acute Stress Disorder and Posttraumatic Stress Disorder. EMDR is given the same status as CBT as an effective treatment for ameliorating symptoms of both acute and chronic PTSD.

Australian Guideline for PTSD

Published in 2007 by the Australian Centre for Posttraumatic Mental Health. The Guidelines state that “adults with PTSD should be provided with trauma-focused interventions (trauma-focused cognitive behavioural therapy [CBT] or eye movement desensitization [EMDR] and reprocessing, in addition to in vivo exposure).

Clinical Guideline for PTSD

Published in March 2005 by the UK ’s National Institute for Clinical Excellence. This Guideline explicitly 'warns' clients to not use other treatments than trauma focused CBT or EMDR. There is also a Power Point Slideshow available to spread the good news.

Cochrane Reviews 2007

There was evidence that EMDR, individual Trauma-focused cognitive behavioral therapy/exposure therapy (TFCBT), stress management and group TFCBT are effective in the treatment of PTSD. Other non-trauma focused psychological treatments did not reduce PTSD symptoms as significantly. There was some evidence that individual TFCBT and EMDR are superior to stress management in the treatment of PTSD at between 2 and 5 months following treatment, and also that TFCBT, EMDR and stress management were more effective than other therapies. Cochrane Database of Systematic Reviews 2007.

Department of Veterans Affairs & Department of Defense, Washington, DC (2010)

VA/DoD Clinical Practice Guideline for the Management of Post-Traumatic Stress. EMDR was one of four therapies given the highest level of evidence and recommended for treatment of PTSD.

Effective Treatments for PTSD: Practice Guidelines from the International Society for Traumatic Stress Studies (2008)

EMDR was ranked as an evidence-based, Level A treatment for PTSD in adults.

EMDRIA Response to IOM Report

Click here to view the EMDRIA Response to and Position Statement on IOM Report on Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations: Initial Assessment.

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