National Medical Policy
Subject:
Transcendental Meditation
Policy Number: NMP72
Effective Date*: October 2003
Updated:
June 2016
This National Medical Policy is subject to the terms in the
IMPORTANT NOTICE
at the end of this document
For Medicaid Plans: Please refer to the appropriate State's Medicaid
manual(s), publication(s), citations(s) and documented guidance for
coverage criteria and benefit guidelines prior to applying Health Net Medical
Policies
The Centers for Medicare & Medicaid Services (CMS)
For Medicare Advantage members please refer to the following for coverage
guidelines first:
Use
X
Source
National Coverage Determination
(NCD)
National Coverage Manual Citation
Local Coverage Determination (LCD)*
Article (Local)*
Other
None
Reference/Website Link
Transcendental Meditation:
http://www.cms.gov/medicare-coveragedatabase/search/advanced-search.aspx
Use Health Net Policy
Instructions
 Medicare NCDs and National Coverage Manuals apply to ALL Medicare members
in ALL regions.
 Medicare LCDs and Articles apply to members in specific regions. To access your
specific region, select the link provided under “Reference/Website” and follow the
search instructions. Enter the topic and your specific state to find the coverage
determinations for your region. *Note: Health Net must follow local coverage
determinations (LCDs) of Medicare Administration Contractors (MACs) located outside their
service area when those MACs have exclusive coverage of an item or service. (CMS
Manual Chapter 4 Section 90.2)
Transcendental Meditation Jun 16
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

If more than one source is checked, you need to access all sources as, on
occasion, an LCD or article contains additional coverage information than
contained in the NCD or National Coverage Manual.
If there is no NCD, National Coverage Manual or region specific LCD/Article,
follow the Health Net Hierarchy of Medical Resources for guidance.
Current Policy Statement
Health Net, Inc. considers transcendental meditation investigational. Although there
continues to be ongoing studies, there remains a lack of large-scale clinical studies
with long-term follow-up, in the peer-reviewed literature validating its effectiveness.
Codes Related To This Policy
NOTE:
The codes listed in this policy are for reference purposes only. Listing of a code in
this policy does not imply that the service described by this code is a covered or noncovered health service. Coverage is determined by the benefit documents and
medical necessity criteria. This list of codes may not be all inclusive.
On October 1, 2015, the ICD-9 code sets used to report medical diagnoses and
inpatient procedures have been replaced by ICD-10 code sets.
ICD-9
N/A
ICD-10
N/A
CPT Codes
90875 Individual psychophysiological therapy incorporating biofeedback training by
any modality (face-to-face with the patient), with psychotherapy (eg, insight
oriented, behavior modifying or supportive psychotherapy); approximately
20-30 minutes
90876 approximately 45-50 minutes
90899 Unlisted psychiatric service or procedure
HCPCS Codes
N/A
Scientific Rationale – Update June 2016
Victorson et al (2016) examined the feasibility and preliminary efficacy of an 8-week,
mindfulness training program (Mindfulness Based Stress Reduction) in a sample of
men on active surveillance on important psychological outcomes including prostate
cancer anxiety, uncertainty intolerance and posttraumatic growth in a pilot
randomized controlled trial. Men were randomized to either mindfulness (n=24) or
an attention control arm (n=19) and completed self-reported measures of prostate
cancer anxiety, uncertainty intolerance, global quality of life, mindfulness and
posttraumatic growth at baseline, 8 weeks, 6 months and 12 months. Participants in
the mindfulness arm demonstrated significant decreases in prostate cancer anxiety
and uncertainty intolerance, and significant increases in mindfulness, global mental
health and posttraumatic growth. Participants in the control condition also
Transcendental Meditation Jun 16
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demonstrated significant increases in mindfulness over time. Longitudinal increases
in posttraumatic growth were significantly larger in the mindfulness arm than they
were in the control arm. The authors concluded while mindfulness training was
found to be generally feasible and acceptable among participants who enrolled in the
8-week intervention as determined by completion rates and open-ended survey
responses, the response rate between initial enrollment and the total number of men
approached was lower than desired (47%). While larger sample sizes are necessary
to examine the efficacy of mindfulness training on important psychological outcomes,
in this pilot study posttraumatic growth was shown to significantly increase over time
for men in the treatment group. Mindfulness training has the potential to help men
cope more effectively with some of the stressors and uncertainties associated with
active surveillance.
Innes et al (2016) reported older adults with subjective cognitive decline (SCD) are
at increased risk not only for Alzheimer's disease, but for poor mental health,
impaired sleep, and diminished quality of life (QOL), which in turn, contribute to
further cognitive decline, highlighting the need for early intervention. The authors
assessed the effects of two 12-week relaxation programs, Kirtan Kriya Meditation
(KK) and music listening (ML), on perceived stress, sleep, mood, and health-related
QOL in older adults with SCD in a randomized controlled trial. Sixty communitydwelling older adults with SCD were randomized to a KK or ML program and asked to
practice 12 minutes daily for 12 weeks, then at their discretion for the following 3
months. At baseline, 12 weeks, and 26 weeks, perceived stress, mood, psychological
well-being, sleep quality, and health-related QOL were measured using wellvalidated instruments. Fifty-three participants (88%) completed the 6-month study.
Participants in both groups showed significant improvement at 12 weeks in
psychological well-being and in multiple domains of mood and sleep quality
(p's≤0.05). Relative to ML, those assigned to KK showed greater gains in perceived
stress, mood, psychological well-being, and QOL-Mental Health (p's≤0.09). Observed
gains were sustained or improved at 6 months, with both groups showing marked
and significant improvement in all outcomes. Changes were unrelated to treatment
expectancies. The authors concluded findings suggest that practice of a simple
meditation or ML program may improve stress, mood, well-being, sleep, and QOL in
adults with SCD, with benefits sustained at 6 months and gains that were particularly
pronounced in the KK group.
Keller et al (2016) investigated the characteristics of cortical activity and stress
coping in migraine patients, meditation experienced subjects, and healthy controls in
a exploratory cross-sectional study. 45 meditation experienced subjects, 46 migraine
patients, and 46 healthy controls took part in the study. Cortical activity was
measured with the contingent negative variation (CNV), a slow cortical event-related
potential. Stress coping was examined with the standardized Stress Coping
Questionnaire SVF-78. A one-way analysis of variance was used to investigate
possible differences between the groups. CNV-amplitude was significantly higher in
migraineurs than in controls. The meditators showed significantly lowest amplitudes.
Migraine patients used negative stress-coping strategies significantly more often
than meditators and healthy controls. Especially the application of the strategy
"rumination" was most frequent in migraine patients and least frequent in
meditators. Moreover, frequent rumination was significantly correlated with high
CNV-amplitudes. Cortical and stress processing in people with meditation experience
was improved compared to migraine patients and healthy controls.
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Zgierska et al (2016) assessed the benefits of mindfulness meditation and cognitive
behavioral therapy (CBT)-based intervention for opioid-treated chronic low back pain
(CLBP) in a 26-week parallel-arm pilot randomized controlled trial (Intervention and
Usual Care versus Usual Care alone). Adults with CLBP, prescribed ≥30mg/day of
morphine-equivalent dose (MED) for at least 3 months. The intervention comprised
eight weekly group sessions (meditation and CLBP-specific CBT components) and
30 minutes/day, 6 days/week of at-home practice. Outcome measures were
collected at baseline, 8, and 26 weeks: primary-pain severity (Brief Pain Inventory)
and function/disability (Oswestry Disability Index); secondary-pain acceptance,
opioid dose, pain sensitivity to thermal stimuli, and serum pain-sensitive biomarkers
(Interferon-γ; Tumor Necrosis Factor-α; Interleukins 1ß and 6; C-reactive Protein).
Thirty-five (21 experimental, 14 control) participants were enrolled and completed
the study. They were 51.8 ± 9.7 years old, 80% female, with severe CLBP-related
disability (66.7 ± 11.4), moderate pain severity (5.8 ± 1.4), and taking 148.3 ±
129.2mg/day of MED. Results of the intention-to-treat analysis showed that,
compared with controls, the meditation-CBT group reduced pain severity ratings
during the study (P = 0.045), with between-group difference in score change
reaching 1 point at 26 weeks (95% Confidence Interval: 0.2,1.9; Cohen's d=0.86),
and decreased pain sensitivity to thermal stimuli (P < 0.05), without adverse events.
Exploratory analyses suggested a relationship between the extent of meditation
practice and the magnitude of intervention benefits. The authors concluded
meditation-CBT intervention reduced pain severity and sensitivity to experimental
thermal pain stimuli in patients with opioid-treated CLBP.
Scientific Rationale – June 2015
Leach et al (2015) reported that the burden on those caring for people with dementia
is substantial, with widespread implications for the caregiver, the care recipient and
the community. Relaxation techniques, such as Transcendental Meditation (TM),
have been shown to reduce stress and anxiety in healthy workers; similar benefits
are anticipated in dementia caregivers. The objective of this study was to ascertain
whether TM can improve psychological stress, quality of life, affect and cognitive
performance in dementia caregivers. The study was conducted as a pilot
prospective, multi-centre, community-based, randomised wait-list controlled trial.
Community-dwelling caregivers of persons with diagnosed dementia were randomly
assigned to a 12-week (14-hour) TM training program or wait-list control.
Participants were assessed for quality of life, stress, affect, cognitive performance
and adverse effects. The feasibility of the study was also evaluated. Seventeen
caregivers were recruited and randomized. Improvements in WebNeuro response
speed scores over time were significantly (p=0.03) greater in the TM group relative
to control. Changes between groups over time in all other primary and secondary
outcome measures did not reach statistical significance. However, there was a trend
toward greater improvement in WebNeuro stress, depression and negativity bias
scores in the TM group. Adverse events were reported amongst 63 % of TM-treated
subjects; however, events were generally transient, of mild-moderate intensity and
only 'possibly' related to TM. The authors concluded dementia caregivers exposed to
TM demonstrated varying degrees of improvement in several measures of cognitive
function, mood, quality of life and stress following exposure to TM. However, as the
pilot study was underpowered, no firm conclusions can be made about the
effectiveness of TM in this caregiver population. Findings from full-scale trials are
now warranted.
Scientific Rationale – Update June 2014
Transcendental Meditation Jun 16
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Keyworth et al (2014) tested a six-week meditation and mindfulness intervention in
people (n = 40) with diabetes mellitus and coronary heart disease. They used a
sequential mixed-methods approach that measured change in worry and thought
suppression and qualitatively explored acceptability, feasibility, and user experience
with a focus group (n = 11) and in-depth interviews (n = 16). The intervention was
highly acceptable, with 90% completing ≥5 sessions. Meditation and mindfulness
skills led to improved sleep, greater relaxation, and more-accepting approaches to
illness and illness experience. At the end of the six-week meditation course, worry,
and thought suppression were significantly reduced. Positive impacts of mindfulnessbased interventions on psychological health may relate to acquisition and
development of meta-cognitive skills but this needs experimental confirmation
Treat et al (2014) compared use of CAM among children aged 3 to 17 years with and
without common neurological conditions (headaches, migraines, seizures) where
CAM might plausibly play a role in their self-management using the 2007 National
Health Interview Survey (NHIS) data. Children with common neurological conditions
reported significantly more CAM use compared to the children without these
conditions (24.0% vs 12.6%, P<.0001). Compared to other pediatric CAM users,
children with neurological conditions report similarly high use of biological therapies
and significantly higher use of mind-body techniques (38.6% vs 20.5%, P<.007). Of
the mind-body techniques, deep breathing (32.5%), meditation (15.1%), and
progressive relaxation (10.1%) were used most frequently. The authors concluded
about one in four children with common neurological conditions use CAM. The nature
of CAM use in this population, as well as its risks and benefits in neurological
disease, deserve further investigation.
Tonelli and Wachholtz (2014) evaluated the effectiveness of meditation as an
immediate intervention for reducing migraine pain as well as alleviating emotional
tension, examined herein as a negative affect hypothesized to be correlated with
pain. Twenty-seven migrainers, with two to ten migraines per month, reported
migraine-related pain and emotional tension ratings on a Likert scale (ranging from 0
to 10) before and after exposure to a brief meditation-based treatment. All
participants were meditation- naïve, and attended one 20-minute guided meditation
session based on the Buddhist "loving kindness" approach. After the session,
participants reported a 33% decrease in pain and a 43% decrease in emotional
tension. The data suggest that a single exposure to a brief meditative technique can
significantly reduce pain and tension, as well as offer several clinical implications. It
can be concluded that single exposure to a meditative technique can significantly
reduce pain and tension. The effectiveness and immediacy of this intervention offers
several implications for nurses.
Scientific Rationale - Update November 2011
Rosenthal et al. (2011) conducted an uncontrolled pilot study to determine whether
transcendental meditation (TM) might be helpful in treating veterans from Operation
Enduring Freedom or Operation Iraqi Freedom with combat-related posttraumatic
stress disorder (PTSD). Five veterans were trained in the technique and followed for
12 weeks. All subjects improved on the primary outcome measure, the Clinician
Administered PTSD Scale (mean change score, 31.4; p = 0.02; df = 4). Significant
improvements were also observed for 3 secondary outcome measures: Clinician's
Global Inventory-Severity (mean change score, 1.60; p < 0.04; df = 4), Quality of
Life Enjoyment and Satisfaction Questionnaire (mean change score, -13.00; p <
0.01; df = 4), and the PTSD Checklist-Military Version (mean change score, 24.00; p
< 0.02; df = 4). TM may have helped to alleviate symptoms of PTSD and improve
Transcendental Meditation Jun 16
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quality of life in this small group of veterans. Larger, placebo-controlled studies
should be undertaken to further determine the efficacy of TM in this population.
Haaga et al. (2011) A randomized wait-list controlled trial (N = 295 university
students) of the effects of the Transcendental Meditation program was conducted in
an urban setting. Substance use was assessed by self-report at baseline and 3
months later. For smoking and illicit drug use, there were no significant differences
between conditions. For alcohol use, sex X intervention condition interactions were
significant; TM instruction lowered drinking rates among male but not female
students. TM instruction could play a valuable role in reducing alcohol use among
male university students. Limitations are noted, along with suggestions for further
research.
Bay et al. (2011) The main aim of this research was to evaluate the effect of
combined therapy using acupressure therapy, hypnotherapy, and transcendental
meditation (TM) on the blood sugar (BS) level in comparison with placebo in type 2
diabetic patients. We used "convenience sampling" for selection of patients with type
2 diabetes; 20 patients were recruited. For collection of data, we used an identical
quasi-experimental design called "nonequivalent control group." Therapy sessions
each lasting 60-90min were carried out on 10 successive days. We prescribed 2
capsules (containing 3g of wheat flour each) for each member of the placebo group
(one for evening and one for morning). Pre-tests, post-tests, and follow-up tests
were conducted in a medical laboratory recognized by the Ministry of Health and
Medical Education of Iran. Mean BS level in the post-tests and follow-up tests for the
experimental group was reduced significantly in comparison with the pre-tests
whereas in the placebo group no changes were observed. Combined therapy
including acupressure therapy, hypnotherapy, and TM reduced BS of type 2 diabetic
patients and was more effective than placebo therapy on this parameter.
Scientific Rationale Initial
Transcendental meditation is a technique to produce a state of rest and relaxation.
Objective evidence for effectiveness of the treatment of medical conditions is lacking
and a professional skill level is not required to train another individual to use this
technique
Review History
October 2003
April 2006
March 2007
March 2011
November 2011
November 2012
November 2013
June 2014
June 2015
June 2016
Medical Advisory Council
Update – no revisions
Coding Update – no revisions
Update – no revisions
Update. Added revised Medicare Table with link to NCD. No
revisions.
Update – no revisions
Update - no revisions
Update – no revisions
Update – no revisions
Update – no revisions
References – Update June 2016
1.
2.
Chan RR, Lehto RH. The Experience of Learning Meditation and Mind/Body
Practices in the COPD Population. Explore (NY). 2016 May-Jun;12(3):171-9.
Innes KE, Selfe TK, Khalsa DS, Kandati S. Effects of Meditation versus Music
Transcendental Meditation Jun 16
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3.
4.
5.
6.
7.
8.
Listening on Perceived Stress, Mood, Sleep, and Quality of Life in Adults with
Early Memory Loss: A Pilot Randomized Controlled Trial. J Alzheimers Dis. 2016
Apr 8.
Kanter G, Komesu YM, Qaedan F, et al. Mindfulness-based stress reduction as a
novel treatment for interstitial cystitis/bladder pain syndrome: a randomized
controlled trial. Int Urogynecol J. 2016 Apr 26.
Keller A, Meyer B, Wöhlbier HG, et al. Migraine and Meditation: Characteristics
of Cortical Activity and Stress Coping in Migraine Patients, Meditators and
Healthy Controls-An Exploratory Cross-Sectional Study. Appl Psychophysiol
Biofeedback. 2016 Mar 16.
Lee J, Song Y, Lindquist R, et al. Nontraditional Cardiac Rehabilitation in Korean
Patients with Coronary Artery Disease. Rehabil Nurs. 2016 Apr 14.
Victorson D, Hankin V, Burns J, et al. Feasibility, acceptability and preliminary
psychological benefits of mindfulness meditation training in a sample of men
diagnosed with prostate cancer on active surveillance: results from a randomized
controlled pilot trial. Psychooncology. 2016 May 3
Salhofer I, Will A, Monsef I, Skoetz N. Meditation for adults with hematological
malignancies. Cochrane Database Syst Rev. 2016 Feb 3;2:CD011157.
Zgierska AE, Burzinski CA, Cox J, et al. Mindfulness Meditation and Cognitive
Behavioral Therapy Intervention Reduces Pain Severity and Sensitivity in OpioidTreated Chronic Low Back Pain: Pilot Findings from a Randomized Controlled
Trial. Pain Med. 2016 Mar 10.
References – Update June 2015
1.
2.
3.
Amtul Z, Arena A, Hirjee H, et al. A randomized controlled longitudinal
naturalistic trial testing the effects of automatic self transcending meditation on
heart rate variability in late life depression: study protocol. BMC Complement
Altern Med. 2014 Aug 19;14:307
Leach MJ, Francis A, Ziaian T. Transcendental Meditation for the improvement of
health and wellbeing in community-dwelling dementia caregivers
[TRANSCENDENT]: a randomised wait-list controlled trial. BMC Complement
Altern Med. 2015 May 8;15(1):145.
Leung NT, Lo MM, Lee TM. Potential therapeutic effects of meditation for
treating affective dysregulation. Evid Based Complement Alternat Med.
2014;2014:402718
References – Update June 2014
1.
2.
3.
4.
5.
Innes KE, Selfe TK. Meditation as a Therapeutic Intervention for Adults at Risk
for Alzheimer's Disease - Potential Benefits and Underlying Mechanisms. Front
Psychiatry. 2014 Apr 23;5:40. eCollection 2014.
Keyworth C, Knopp J, Roughley K, et al. A mixed-methods pilot study of the
acceptability and effectiveness of a brief meditation and mindfulness intervention
for people with diabetes and coronary heart disease. Behav Med.
2014;40(2):53-64.
Manchanda SC, Madan K. Yoga and meditation in cardiovascular disease. Clin
Res Cardiol. 2014 Jan 25.
Tonelli ME, Wachholtz AB. Meditation-based treatment yielding immediate relief
for meditation-naïve migraineurs. Pain Manag Nurs. 2014 Mar;15(1):36-40.
Treat L, Liesinger J, Ziegenfuss JY, et al. Patterns of complementary and
alternative medicine use in children with common neurological conditions. Glob
Adv Health Med. 2014 Jan;3(1):18-24.
References – Update November 2012
Transcendental Meditation Jun 16
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1.
2.
Fox KC, Zakarauskas P, Dixon M, et al. Meditation Experience Predicts
Introspective Accuracy. PLoS One. 2012;7(9):e45370. Epub 2012 Sep 25.
Guglietti CL, Daskalakis ZJ, Radhu N, et al. Meditation-related increases in
GABA(B) modulated cortical inhibition. Brain Stimul. 2012 Sep 7.
References – Update November 2011
1.
2.
3.
4.
Bay R, Bay F. Combined Therapy Using Acupressure Therapy, Hypnotherapy,
and Transcendental Meditation versus Placebo in Type 2 Diabetes. J Acupunct
Meridian Stud. 2011 Sep;4(3):183-6.
Haaga DA, Grosswald S, Gaylord-King C, et al. Effects of the Transcendental
Meditation Program on Substance Use among University Students. Cardiol Res
Pract. 2011 Mar 21;2011:537101.
Rosenthal JZ, Grosswald S, Ross R, et al. Effects of transcendental meditation in
veterans of Operation Enduring Freedom and Operation Iraqi Freedom with
posttraumatic stress disorder: a pilot study. Mil Med. 2011 Jun;176(6):626-30.
Travis F. Comparison of coherence, amplitude, and eLORETA patterns during
Transcendental Meditation and TM-Sidhi practice.
References – Update March 2011
1.
2.
3.
4.
5.
6.
Chiesa A, Serretti A. Mindfulness based cognitive therapy for psychiatric
disorders: A systematic review and meta-analysis. Psychiatry Res. 2010 Sep 14
Erwin Wells R, Phillips RS, McCarthy EP. Patterns of mind-body therapies in
adults with common neurological conditions. Neuroepidemiology.
2011;36(1):46-5
Gross CR, Kreitzer MJ, Thomas W, et al. Mindfulness-based stress reduction for
solid organ transplant recipients: a randomized controlled trial. Altern Ther
Health Med. 2010 Sep-Oct; 16(5):30-8.
Krisanaprakornkit T, Ngamjarus C, Witoonchart C, Piyavhatkul. Meditation
therapies for attention-deficit/hyperactivity disorder (ADHD). Cochrane
Database Syst Rev. 2010 Jun 16;(6):CD0065
Saquib J, Madlensky L, Kealey S, et al. Classification of CAM Use and Its
Correlates in Patients With Early-Stage Breast Cancer. Integr Cancer Ther. 2011
Mar 7.
Zeidan F, Johnson SK, Gordon NS, Goolkasian P. Effects of brief and sham
mindfulness meditation on mood and cardiovascular variables. J Altern
Complement Med. 2010 Aug; 16(8):867-73.
References – Update March 2007
Lamanque P, Daneault S. Does meditation improve the quality of life for
patients living with cancer? Can Fam Physician. 2006 Apr; 52:474-5.
2. Jayadevappa R, Johnson JC, Bloom BS, et al. Effectiveness of transcendental
meditation on functional capacity and quality of life of African Americans with
congestive heart failure: a randomized control study. Ethn Dis. 2007 Winter;
17(1):72-7.
3. Arias AJ, Steinberg K, Banga A, Trestman RL. Systematic review of the efficacy
of meditation techniques as treatments for medical illness. J Altern Complement
Med. 2006 Oct; 12(8):817-32.
1.
References - Initial
1. Tacon AM. Meditation as a complementary therapy in cancer. Fam Community
Health. 2003 Jan-Mar;26(1):64-73
Transcendental Meditation Jun 16
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2. Tacon AM, McComb J, Caldera Y, Randolph P. Mindfulness meditation, anxiety
reduction, and heart disease: a pilot study. Fam Community Health. 2003 JanMar; 26(1):25-33.
3. Vyas R, Dikshit N. Effect of meditation on respiratory system, cardiovascular
system and lipid profile. Indian J Physiol Pharmacol. 2002 Oct; 46(4):487-91.
Important Notice
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Health Net's National Medical Policies (the "Policies") are developed to assist Health Net in administering
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Transcendental Meditation Jun 16
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Policy Limitation: Legal and Regulatory Mandates and Requirements
The determinations of coverage for a particular procedure, drug, service or supply is subject to applicable
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Reconstructive Surgery
CA Health and Safety Code 1367.63 requires health care service plans to cover reconstructive surgery.
“Reconstructive surgery” means surgery performed to correct or repair abnormal structures of the body
caused by congenital defects, developmental abnormalities, trauma, infection, tumors, or disease to do
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(1) To improve function or
(2) To create a normal appearance, to the extent possible.
Reconstructive surgery does not mean “cosmetic surgery," which is surgery performed to alter or reshape
normal structures of the body in order to improve appearance.
Requests for reconstructive surgery may be denied, if the proposed procedure offers only a minimal
improvement in the appearance of the enrollee, in accordance with the standard of care as practiced by
physicians specializing in reconstructive surgery.
Reconstructive Surgery after Mastectomy
California Health and Safety Code 1367.6 requires treatment for breast cancer to cover prosthetic devices
or reconstructive surgery to restore and achieve symmetry for the patient incident to a mastectomy.
Coverage for prosthetic devices and reconstructive surgery shall be subject to the co-payment, or
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Transcendental Meditation Jun 16
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