PG0094-02/01/2024
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Medical Policy
Biofeedback and Neurofeedback
Policy Number: PG0094
Last Review: 02/01/2024
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GUIDELINES:
• This policy does not certify benefits or authorization of benefits, which is designated by each individual
policyholder terms, conditions, exclusions, and limitations contract. It does not constitute a contract or
guarantee regarding coverage or reimbursement/payment. Self-Insured group specific policy will supersede
this general policy when group supplementary plan document or individual plan decision directs otherwise.
• Paramount applies coding edits to all medical claims through coding logic software to evaluate the accuracy
and adherence to accepted national standards.
• This medical policy is solely for guiding medical necessity and explaining correct procedure reporting used to
assist in making coverage decisions and administering benefits.
SCOPE:
X Professional
X Facility
DESCRIPTION:
Biofeedback or neurofeedback is a noninvasive technique intended to teach an individual self-regulation of
certain physiological activity for the purpose of improving health and performance through voluntary control.
Biofeedback is a therapeutic process that electronically monitors the bodies’ physiological functions, such as
breathing, heart rate, blood pressure, skin temperature, salivation, peripheral vasomotor activity and muscle
tension, which are fed back to the individual by means of sounds, lights or electronic devices. Biofeedback is a
process that teaches individuals to voluntary control their own autonomic and neuromuscular functions. It
emphasizes relaxation and stress-reducing techniques. Most proponents believe that by using these techniques,
individuals can learn to control a variety of physiological responses formerly thought to be completely involuntary
and thereby, help manage anxiety and pain commonly associated with stress reactions. Biofeedback is
considered an alternative medicine technique.
There are several different types of biofeedback. The three most commonly used forms of biofeedback therapy
are electromyography (EMG), thermal biofeedback, and neurofeedback or electroencephalography (EEG).
Various forms of biofeedback appear to be effective for a narrow range of health problems. The biofeedback
modality selected for therapy depends on the condition to be treated.
1. EMG biofeedback measures muscle tension and is proposed for the treatment of chronic muscle stiffness,
injury and pain (e.g., neck and back pain); headaches, asthma, incontinence; and intestinal symptoms.
2. Thermal or temperature biofeedback measures skin temperature and is proposed for the treatment of
circulatory disorders, such as headaches, hypertension, and Raynaud’s phenomenon.
3. Galvanic skin response (GSR) biofeedback, also called electrodermal response (EDR), electro dermal
activity (EDA), skin conductance response (SCR) or skin conductance level (SCL) biofeedback, measures
electrical conductance in the skin associated with sweat gland activity and perspiration. GSR is proposed for
the treatment of anxiety disorders and phobias.
4. Neurofeedback, also called electroencephalogram (EEG) biofeedback, brainwave biofeedback or
neurotherapy, describes techniques for providing real-time feedback about neuronal activity/physical signs,
as measured by electroencephalogram biofeedback, functional magnetic resonance imaging, or near-
infrared spectroscopy, to teach members to self-regulate physiologic functions and mental states.
Neurofeedback measures alpha (associated with relaxation and meditation) and theta (associated with
focused attention) brainwave activity. Neurofeedback may use several techniques in an attempt to
normalize unusual patterns of brain function in members with various psychiatric and central nervous system
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disorders, i.e. autism spectrum disorder, insomnia and sleep disorders, learning disabilities, Tourette
syndrome, traumatic brain injury, seizure disorders, premenstrual dysphoric disorder, menopausal hot
flashes, depression, stress management, panic and anxiety disorders, posttraumatic stress disorder,
substance abuse disorders, eating disorders, migraine headaches, stroke, Parkinson disease, bromyalgia,
tinnitus, and attention-deficit/hyperactivity disorder.
Neurofeedback differs from established forms of biofeedback in that the information fed back to the member (via
EEG tracings, functional magnetic resonance imaging, near infrared spectroscopy) is a direct measure of global
neuronal activity, or brain state, compared with feedback of the centrally regulated physiologic processes, such
as tension of specific muscle groups or skin temperature. Neurofeedback is being studied for a variety of medical
and psychological conditions. However, the evidence in the published peer-reviewed scientific literature does not
support the efficacy of EEG biofeedback.
Although there are numerous biofeedback devices available for home use, biofeedback should be performed by
a trained professional in a clinical setting. Examples of home devices include: StressEraser® (Helicor, Inc., New
York, NY) for mind and body relaxation; BrainMaster (BrainMaster Technologies, Inc., Oakwood Village, OH)
EEG biofeedback devices; GSR/Temp2X™ (Biofeedback Instrument Corp., New York, NY) temperature
biofeedback system; and RESPeRate (Intercure Ltd., Lod, Israel) which uses therapeutic paced breathing to
lower blood pressure. Although devices used during neurofeedback may be subject to FDA regulation, and
approved by the FDA, the process of neurofeedback itself is a procedure, and, therefore, not subject to FDA
approval.
The evidence in the published peer-reviewed scientific literature and professional societies support the safety
and efficacy of biofeedback for the treatment of constipation, and the treatment of stress, urge, mixed and
overflow urinary incontinence. The evidence in the published peer-reviewed scientific literature does not support
the therapeutic effectiveness of biofeedback for any other indication due to the small number of clinical trials
and/or small heterogeneous member populations, short-term follow-ups, lack of documentation of sustained
benefits and lack of a comparison to established therapeutic modalities. In most cases, member selection criteria
for biofeedback have not been established.
Biofeedback therapy differs from electromyography, which is a diagnostic procedure used to record and study
the electrical properties of skeletal muscle. An electromyography device may be used to provide feedback with
certain types of biofeedback.
POLICY:
Paramount Commercial Insurance Plans and Elite (Medicare Advantage) Plans
• Neurofeedback, also known as electroencephalogram (EEG) biofeedback, is considered
investigational and not medically necessary for all conditions
Paramount Commercial Insurance Plans
• Individual psychophysiological therapy incorporating biofeedback training (90875 and 90876)
does not require prior authorization, however, must meet medically indicated criteria as listed
below.
• Biofeedback (90901, 90912 and 90913) does not require prior authorization, however, must meet
medically indicated criteria as listed below.
Elite (Medicare Advantage) Plans
• Biofeedback (90901, 90912 and 90913) does not require prior authorization, however, must meet
medically indicated criteria as listed below.
• Effective 01/01/2023: Individual psychophysiological therapy incorporating biofeedback training
(90875 and 90876) is non-covered. CMS has indicated a reimbursement of Status N – non-covered
Paramount Medicaid Advantage
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• Individual psychophysiological therapy incorporating biofeedback training (90875 and 90876) is
non-covered, per the Ohio Department of Medicaid (ODM) Appendix DD fee schedule
• Biofeedback (90901, 90912, 90913) is non-covered, per ODM Appendix DD fee schedule
Neurofeedback, also known as electroencephalogram (EEG) biofeedback & In-home biofeedback devices
(E0746) are non-covered for all product lines. There is insufficient evidence to support the use of
Neurofeedback as a treatment for behavioral health or medical indications.
COVERAGE CRITERIA:
Paramount Commercial Insurance Plans and Elite (Medicare Advantage) Plans
Any services for biofeedback that are considered primarily educational or training in nature are generally NOT
covered under many benefit Plans. Biofeedback may be excluded by contract as alternative medicine. Please
consult the member’s individual contract regarding Plan coverage
Biofeedback is considered reasonable and medically necessary for the following:
• Muscle re-education of specific muscle groups
• Treatment of pathological (disease-based) muscle abnormalities of spasticity
• Incapacitating muscle spasm or weakness when more conventional treatments (e.g., heat, cold,
massage, exercise, support) have not been successful
• The treatment of fecal incontinence related to constipation when the underlying cause is determined to
be an ineffective anal sphincter squeeze function
• Levator ani syndrome, also known as anorectal pain syndrome
• The treatment of stress and/or urge incontinence
• The treatment of persistent post-prostatectomy urinary incontinence when more conventional treatments
(e.g., pharmacology, timed voiding, pelvic muscle exercises) have not been successful
• Cancer pain
• Chronic back pain as part of a rehabilitation program
• Migraine or tension headaches (muscle (EMG), skin or thermal biofeedback; EEG biofeedback is
considered experimental and investigational for this indication because its effectiveness for this indication
has not been established)
The member must be motivated to actively participate in the treatment plan, including being responsive to the
care plan requirements (e.g., practice and follow-through at home). The individual is capable of participating in
the treatment plan (physically as well as intellectually). Members selected for biofeedback training must have the
ability to understand analog or digital signals using auditory or visual display. If the member is a child, support
and guidance must be available. In addition, these members must be self-motivated to learn voluntary control
through the observation of biofeedback and perform their personalized home exercise prescription usually on a
daily basis.
Rectal incontinence:
Biofeedback for the treatment of rectal incontinence related to dyssynergia-type constipation in adults may be
considered medically necessary as demonstrated by meeting ALL of the following indications:
• Anorectal testing should not be done until a thorough history and appropriate physical examination has
been performed, medications that can cause constipation are discontinued, constipation secondary to
other diseases has been excluded and there has been a trial of fiber and/or other laxatives; and
o Anorectal Manometry is a diagnostic test that measures the anal sphincter pressures and
provides an assessment of rectal sensation, rectoanal reflexes, and rectal compliance, thus
measuring the weakness of the external anal sphincter.
o Electromyography studies (EMG) of the anal or urethral sphincter is a diagnostic test that
measures muscle activity and that is used to assist in evaluating fecal or urinary incontinence,
dysfunctional elimination of bowel and bladder and neurogenic bladder dysfunction leading to
functional abnormalities of the muscular sphincter.
• When pelvic floor retraining or biofeedback is being considered, the patient should be capable of
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participating in the therapy, physically and intellectually; and
• Symptoms of functional constipation that meet Rome IV criteria; and
o Rome IV diagnostic criteria (fulfilled for the last 3 months with symptom onset at least 6 months
prior to diagnosis) for functional constipation include:
▪ Must include TWO or more of the following
▪ Loose stools are rarely present without the use of laxatives;
▪ Insufficient criteria for irritable bowel syndrome.
▪ Straining during more than one-fourth (25%) of defecations,
▪ Lumpy or hard stools (Bristol Stool Funn Scale 1-2) more than one-fourth (25%) of
defecations,
▪ Sensation of incomplete evacuation more than one-fourth (25%) of defecations,
▪ Sensation of anorectal obstruction/blockage more than one-fourth (25%) of defecations,
▪ Manual maneuvers to facilitate more than one-fourth (25%) of defecations (e.g., digital
evacuation, support of the pelvic floor),
▪ Fewer than three spontaneous bowel movements per week
• Objective physiologic evidence of pelvic floor dyssynergia demonstrated by inappropriate contraction of
the pelvic floor muscles or less than 20% relaxation of basal resting sphincter pressure by manometry,
imaging or electromyography (EMG); and
• Failed a 3-month trial of standard treatments for constipation including laxatives, dietary changes, and
exercises (as many of the previous as are tolerated).
Biofeedback is considered experimental, investigational and/or unproven as a treatment of constipation/fecal
incontinence in adults and children in all other situations, as there is insufficient evidence to support a conclusion
concerning the health outcomes or benefits associated with this procedure, including but not limited-to:
• Isolated internal anal sphincter weakness
• Overflow incontinence associated with behavioral or psychiatric disorders
• Neurological disorders associated with substantial loss of rectal sensation and/or the inability to contract
the external anal sphincter
• Decreased rectal storage capacity from resection, inflammation, or fibrosis
• Suspected or established major structural damage to continence mechanisms
• Chronic constipation in members with organic neuromuscular impairment who have difficulty with outlet
obstruction
Stress, urgency, mixed, or overflow urinary incontinence:
Biofeedback for the treatment stress and/or urge urinary incontinence may be considered medically necessary
as demonstrated by meeting the following indications:
• Cognitively intact adult members when documentation supports a previously failed trial of pelvic muscle
exercise (PME) training. A failed trial is observed when no significant clinical improvement in urinary
incontinence is noted after completing four weeks of a physician plan of pelvic muscle exercises to
increase periurethral muscle strength.
• For children with daytime urinary dysfunction when the child meets the following criteria:
o Ages four years or older
o Neurologic, anatomic, infectious or functional causes have been ruled out
o Other alternative options have been unsuccessful, e.g., timed voiding, prophylactic antibacterial
therapy for recurrent urinary tract infections, short term anticholinergic medications to assist
developing a normal voiding pattern
o Able to comprehend and follow verbal instructions
Documentation in the member’s medical record for biofeedback training for the treatment of stress, urge, or
persistent post-prostatectomy urinary incontinence must support medical necessity and must provide a clear
history of conventional treatments unsuccessfully tried before the initiation of biofeedback (e.g., pharmacology;
lifestyle changes, such as weight loss, dietary changes, smoking cessation; behavioral modification training,
such as bladder training, scheduled or prompted voiding, fluid intake modification; heat, cold, or massage). In
addition, documentation must show evidence that the member has failed a 4-week prescribed trial of pelvic
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muscle exercises (e.g., Kegel’s exercise) to increase periurethral muscle strength, which resulted in no clinically
significant improvement in urinary incontinence prior to starting biofeedback. This information is usually found in
the history and physical, office/progress notes and treatment plan.
Chronic pain
Biofeedback for the treatment for chronic pain may be considered medically necessary as part of a rehabilitation
program. The purpose of electromyography (EMG) biofeedback in patients who have chronic pain is to provide a
treatment option that is an alternative to or an improvement on existing therapies.
Muscle re-education
Biofeedback be considered medically necessary for muscle re-education of specific muscle groups or for
treating pathological muscle abnormalities of spasticity, incapacitating muscle spasm (including pain due to
spasm), or weakness when more conventional treatments (heat, cold, massage, exercise, support) have not
been successful. Biofeedback is not covered for treatment of ordinary muscle tension states or for
psychosomatic conditions.
Migraine and tension headaches:
Thermal biofeedback combined with relaxation training or electromyography (EMG) biofeedback may be
considered medically necessary as treatment options in management of tension-type and migraine headaches.
. In general, electromyographic biofeedback is used to treat tension headaches. With this procedure, electrodes
are attached to the temporal muscles, and the patient attempts to reduce muscle tension. Feedback on
achievement of a decrease in muscle tension is provided to the subject, reinforcing those activities (behaviors or
thoughts) that are effective. Thermal biofeedback is a commonly employed technique for migraine headache, in
which patients learn to increase the temperature of their fingertips through the use of imagery and relaxation. In
this technique, a temperature sensor is placed on the finger, and the subject is taught to increase peripheral
vasodilation by providing feedback on skin temperature, an effect that is mediated through sympathetic activity.
The combination of thermal biofeedback and relaxation training has also been used to improve migraine
symptoms. Biofeedback for the treatment of cluster headache is investigational.
Before a biofeedback program for management of tension-type and migraine headaches is introduced, a
physician must determine that the headaches are not pathological in nature. Such pathologies include:
• Brain tumors; or
• Hematoma; or
• Edema; or
• Aneurysm; or
• Disease of the eyes, ears, or sinus
Coverage for biofeedback management of tension-type and migraine headaches typically indications required no
more than 20 office-based sessions. Requests for additional sessions are subject to medical necessity review.
The physician and/or the non-physician practitioner (NPP) must provide direct supervision during biofeedback
training when the service is rendered in the physician’s office. Direct supervision in the office setting does not
mean that the physician must be present in the same room with his or her aide. However, the physician must be
present in the office suite and immediately available to provide assistance and direction throughout the time the
aide is performing services.
Documentation maintained by the performing provider must support that the indication for biofeedback training is
reasonable and necessary and that treatments that are more conventional have not been successful (e.g., heat,
cold, massage, exercise, support).
• Biofeedback therapy must be ordered by the member’s attending provider
• A written treatment plan must include the specific diagnosis/conditions to be treated, long and short term
goals and measurable objectives and the time frame and the frequency of treatment in which the goals
and objectives will be achieved
The documentation maintained by the performing provider should be legible and must be made available upon
request.
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Biofeedback is non-covered for all other indications including, but not limited-to:
• Addictions
• Allergy
• Anger management
• Anterior shoulder instability or pain
• Anxiety disorders
• As a rehabilitation modality for spasmodic torticollis, spinal cord injury, or following knee surgeries
• Attention deficit hyperactivity disorder (ADHD)
• Autism
• Balance training (with tongue-placed electrotactile biofeedback or visual interactive biofeedback)
• Bell's palsy (idiopathic facial paralysis)
• Cardiovascular diseases (e.g., heart failure)
• Childhood apraxia of speech
• Chronic abacterial prostatitis
• Chronic fatigue syndrome
• Chronic pain (e.g., back pain, fibromyalgia, neck pain) other than migraine and tension headache
• Cleft palate speech (nasopharyngoscopic biofeedback)
• Daytime syndrome of urinary frequency
• Depression
• Diabetes
• Epilepsy
• Facial pain
• Functional dysphonia
• Home biofeedback (for any indication)
• Hypertension (e.g. RESPeRATE Device)
• Improvement of anorectal/bowel functions after sphincter-saving surgery for rectal cancer
• Insomnia
• Labor pain
• Neurogenic bladder
• Non-neuropathic voiding disorders
• Ordinary muscle tension states
• Pain associated with multiple sclerosis
• Panic disorders (e.g., FreeSpira breathing system)
• Pelvic floor dysfunction
• Peripheral arterial disease (e.g., intermittent claudication)
• Pre-term labor
• Prophylaxis of medication overuse headache and pediatric migraine
• Post-trauma stress disorder
• Psychosis
• Psychosomatic conditions
• Raynaud's disease/phenomenon
• Rehabilitation modality for spasmodic torticollis, spinal cord injury, or following knee surgeries
• Sleep bruxism
• Spasticity secondary to cerebral palsy
• Toe-out gait modification/retraining in people with knee osteoarthritis
• Tourette’s syndrome
• Treatment of food/substance craving
• Tremor
• Type 2 diabetes
• Urinary retention
• Vaginal tear
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• Vaginismus
• Vertigo/disequilibrium
• Visual disorders
• Vulvodynia
Biofeedback training will not be covered for mechanical urinary incontinence, psychosomatic conditions, or
functional urinary incontinence, as these types of urinary incontinence are not amenable to biofeedback training.
Biofeedback training is not covered as a Behavioral Health intervention.
Neurofeedback is considered investigational and not medically necessary for ALL conditions including, but not
limited to:
• Anxiety
• Asperger syndrome
• Asthma
• Attention-deficit hyperactivity disorder
• Autistic spectrum disorders
• Cardiovascular conditions
• Cigarette cravings
• Cluster headaches
• Cognitive impairment
• Depression
• Epilepsy
• Fibromyalgia
• Headache
• Insomnia and sleep disorders
• Obsessive-compulsive disorder
• Overweight and obesity
• Post-traumatic stress disorder
• Primary headaches
• Schizophrenia
• Substance use disorders
• Traumatic brain injury
AutoMove AM800 is considered experimental and investigational for neuromuscular rehabilitation of post-stroke
patients because its effectiveness for this indication has not been established. Although triggered by EMG,
AutoMove AM800 is a neuromuscular electrical stimulator, it is not biofeedback. Furthermore, available evidence
does not support the effectiveness of this modality in treating post-stroke patients.
The use of home biofeedback devices is considered not medically necessary and not covered for all conditions.
As they are considered experimental, investigational or unproven and are non-covered:
• In-home biofeedback devices (E0746)
This policy applies to biofeedback therapy rendered by a practitioner in an office or other facility setting. Home
use of biofeedback therapy is not covered. Biofeedback training in a group setting is not covered.
CODING/BILLING INFORMATION:
The appearance of a code in this section does not necessarily indicate coverage. Codes that are covered may have selection
criteria that must be met. Payment for supplies may be included in payment for other services rendered.
CPT CODES
90875
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90876
90901
90912
90913
Neurofeedback is specific to electroencephalogram (EEG) biofeedback. There is no specific CPT code
for neurofeedback. Procedures 90875, 90876 and 90901 are used to describe neurofeedback.
HCPCS CODE
E0746
ICD-10-CM CODES
G04.1
Tropical spastic paraplegia
G35
Multiple sclerosis
G43.001-
G43.919
Migraine
G44.201-
G44.229
Tension type headache
G81.00 - G81.94
Flaccid hemiplegia affecting unspecified side - Hemiplegia, unspecified affecting left
nondominant side
G82.20 - G82.22
Paraplegia, unspecified - Paraplegia, incomplete
G82.50 - G82.54
Quadriplegia, unspecified - Quadriplegia, C5-C7 incomplete
G83.0
Diplegia of upper limbs
G83.10 - G83.34
Monoplegia of lower limb affecting unspecified side - Monoplegia, unspecified affecting left
nondominant side
G83.4
Cauda equina syndrome
G89.3
Neoplasm related pain
I67.89
Other cerebrovascular disease
K59.00 - K59.09
Constipation, unspecified - Other constipation
K59.4
Anal spasm
M25.78
Osteophyte, vertebrae
M47.011 - M47.9
Anterior spinal artery compression syndromes, occipito-atlanto-axial region - Spondylosis,
unspecified
M48.10 - M48.9
Ankylosing hyperostosis [Forestier], site unspecified - Spondylopathy, unspecified
M62.40 - M62.49
Contracture of muscle, unspecified site - Contracture of muscle, multiple sites
M62.81
Muscle weakness (generalized)
M62.830 -
M62.838
Muscle spasm of back - Other muscle spasm
N31.2
Flaccid neuropathic bladder, not elsewhere classified
N31.9
Neuromuscular dysfunction of bladder, unspecified
N36.42
Intrinsic sphincter deficiency (ISD)
N36.43
Combined hypermobility of urethra and intrinsic sphincter deficiency
N36.44
Muscular disorders of urethra
N39.3
Stress incontinence (female) (male)
N39.41
Urge incontinence
N39.42
Incontinence without sensory awareness
N39.43
Post-void dribbling
N39.44
Nocturnal enuresis
N39.45
Continuous leakage
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N39.46
Mixed incontinence
N39.490
Overflow incontinence
R15.0 - R15.9
Incomplete defecation - Full incontinence of feces
R32
Unspecified urinary incontinence
R33.0
Drug induced retention of urine
R33.8
Other retention of urine
R33.9
Retention of urine, unspecified
R35.0
Frequency of micturition
R39.14
Feeling of incomplete bladder emptying
R39.15
Urgency of urination
R39.191
Need to immediately re-void
REVISION HISTORY EXPLANATION: ORIGINAL EFFECTIVE DATE: 08/01/2006
Date
Explanation & Changes
09/11/12
• Per the Medical Policy Steering Committee, procedure 90911 will be covered for all
members when medically necessary without prior authorization
01/14/14
• Removed CPT codes 51784-51785, 97110, 97112, 97530 & 97535
• ICD-10 Codes added from ICD-9 conversion
• Policy reviewed and updated to reflect most current clinical evidence
• Approved by Medical Policy Steering Committee as revised
07/11/17
• Changed name from Anorectal Biofeedback to Biofeedback
• Added code 90901 as covered for HMO, PPO, Individual Marketplace, Elite per CMS
guidelines, and non-covered for Advantage per ODM guidelines
• Added code E0746 as non-covered for all product lines
• Removed ICD-9 codes & added many ICD-10 codes per CMS guidelines
• Policy reviewed and updated to reflect most current clinical evidence per Medical Policy
Steering Committee
12/14/2020
• Medical policy placed on the new Paramount Medical policy format
06/01/2021
• Changed Medical Policy name from Biofeedback to Biofeedback and Neurofeedback
• Removed deleted CPT code 90911
• Added new CPT codes 90912 and 90913
• Policy reviewed and updated to reflect most current clinical evidence
02/01/2023
• Policy reviewed and updated to reflect most current clinical evidence
• Effective 01/01/2023: Individual psychophysiological therapy incorporating biofeedback
training (90875 and 90876) is non-covered for the Medicare Advantage Plans. CMS has
indicated a reimbursement of Status N – non-covered
• Medical Policy updated to reflect Medicaid coverage to Anthem as of 02/01/2023
02/01/2024
• Medical Policy placed on the new Paramount Medical policy format
Paramount reserves the right to review and revise our policies periodically when necessary. When
there is an update, we will publish the most current policy to
https://www.paramounthealthcare.com/providers/medical-policies/policy-library
REFERENCES/RESOURCES
Centers for Medicare and Medicaid Services, CMS Manual System and other CMS publications and
services https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals https://www.cms.gov/Regulations-
and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs
American Medical Association, Current Procedural Terminology (CPT®) and associated publications and
services https://www.ama-assn.org/amaone/cpt-current-procedural-terminology
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Centers for Medicare and Medicaid Services, Healthcare Common Procedure Coding System, HCPCS
Release and Code Sets https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets/HCPCS-Quarterly-
Update
U.S. Preventive Services Task Force, https://www.uspreventiveservicestaskforce.org/uspstf/
Industry Standard Review
Hayes, Inc., https://www.hayesinc.com/
Industry Standard Review