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MP 2.01.06


Medical Policy
Original Policy Date
Last Review Status/Date
No routine review scheduled/1:2003
Return to Medical Policy Index


Our medical policies are designed for informational purposes only and are not an authorization, or an explanation of benefits, or a contract.  Receipt of benefits is subject to satisfaction of all terms and conditions of the coverage.  Medical technology is constantly changing, and we reserve the right to review and update our policies periodically.


Hypnosis is an induced state in which there is an increased amenability and responsiveness to suggestions and commands.


Hypnosis is considered medically necessary when used to control acute or chronic pain, or as an adjunct to psychotherapy.

Hypnosis used as an anesthesia is considered investigational.

Policy Guidelines

No applicable information

Benefit Application

BlueCard/National Account Issues

Hypnosis is payable as an integral part of a medical visit at the level of care rendered (e.g., brief, intermediate) or as an integral part of psychotherapy. It is not a separate benefit.


A search of the literature was completed through the MEDLINE database for the period of January 1992 through April 1995. The search strategy focused on references containing the following Medical Subject Headings:

– Hypnosis

Research was limited to English-language journals on humans.





CPT  90880  Medical hypnotherapy 
ICD-9 Procedure  94.32  Hypnosis (psychotherapeutic) for anesthesia 
ICD-9 Diagnosis    Acute pain and chronic pain. See “pain” for part of body in ICD-9. Psychotherapy: See specific mental diagnosis in ICD-9 
HCPCS  No code   
Type of Service  Medical 
Place of Service  Outpatient 



Policy History

Date Action Reason
12/1/95 Add to Medicine section New Policy
08/18/00 Replace Policy Archived Policy
07/12/02 Replace Policy Policy reviewed without literature review; new review date only
04/29/03 Replace Policy Policy no longer scheduled for literature review.

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