Retired Local Coverage Article Billing and Coding

Billing and Coding: Biofeedback

A57635

Expand All | Collapse All
Retired

Contractor Information

Article Information

General Information

Article ID
A57635
Article Title
Billing and Coding: Biofeedback
Article Type
Billing and Coding
Original Effective Date
10/03/2018
Revision Effective Date
01/01/2020
Revision Ending Date
04/06/2023
Retirement Date
04/06/2023
AMA CPT / ADA CDT / AHA NUBC Copyright Statement

CPT codes, descriptions and other data only are copyright 2022 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

Current Dental Terminology © 2022 American Dental Association. All rights reserved.

Copyright © 2022, the American Hospital Association, Chicago, Illinois. Reproduced with permission. No portion of the American Hospital Association (AHA) copyrighted materials contained within this publication may be copied without the express written consent of the AHA. AHA copyrighted materials including the UB‐04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work without the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at 312‐893‐6816.

Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions; and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates.

CMS National Coverage Policy

N/A

Article Guidance

Article Text

This First Coast Billing and Coding Article for Local Coverage Determination (LCD) L33615 Biofeedback provides billing and coding guidance for frequency limitations as well as diagnosis limitations that support diagnosis to procedure code automated denials. However, services performed for any given diagnosis must meet all of the indications and limitations stated in the LCD, the general requirements for medical necessity as stated in CMS payment policy manuals, any and all existing CMS national coverage determinations, and all Medicare payment rules.

Refer to the LCD for reasonable and necessary requirements and limitations.

The redetermination process may be utilized for consideration of services performed outside of the reasonable and necessary requirements in the LCD.

Coding Guidelines

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.

CPT code 51784, Electromyography studies (EMG) of anal or urethral sphincter, other than needle, any technique and CPT code 51785, Electromyography studies (EMG) of anal or urethral sphincter, any technique are diagnostic tests that study the electrical activity in the anal or urethral sphincter muscles and are performed on patients with voiding dysfunction. CPT code 91122, Anorectal manometry is a diagnostic test used to diagnose fecal incontinence and constipation and may be appropriate to use in biofeedback training, when such training is used as an adjunct to the treatment of these two disorders.

Biofeedback training (CPT codes 90912 and 90913) includes the components of EMG or manometry procedures needed to interpret the biofeedback signal. Medicare would only expect to see CPT codes 51784, 51785, and 91122 billed during the initial diagnostic exam. There may be occasions when the physician feels one of these diagnostic tests are needed at the end of the patient’s course of treatment. The additional diagnostic testing would be expected to be performed during the last biofeedback session. Refer to LCD L37943 Anorectal Manometry and Electromyography (EMG) of the Urinary and Anal Sphincters for covered indications and limitations.

Notice: It is not appropriate to bill Medicare for services that are not covered (as described by the entire LCD) as if they are covered. When billing for non-covered services, use the appropriate modifier.

Documentation Requirements

  1. All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
  2. Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service[s]). The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
  3. The submitted medical record must support the use of the selected ICD-10-CM code(s). The submitted CPT/HCPCS code must describe the service performed. 
  4. The documentation for the use of biofeedback training for persons with urinary incontinence would include:
  1. A baseline evaluation
  • History–a focused medical, neurologic and genitourinary history. Areas to assess would include duration and characteristics of urinary incontinence (UI); the most bothersome symptom(s) to the patient; frequency, timing and amount of continent voids and incontinent episodes; precipitants of incontinence (cough, laugh, sneeze, new medications, surgery, etc); other urinary tract symptoms; daily fluid intake; bowel habits; alteration in sexual function due to UI; amount and type of perineal pads or protective devices; previous treatments for UI and effects on UI; and expectations of treatment.
  • Mental status evaluation–the assessment would include both the cognitive ability and the motivation to self toilet.
  • Functional Assessment–areas to assess include manual dexterity, mobility, ability to toilet unaided, uses of physical or chemical restraints. 
  • Evaluation of the individual’s living environment –areas to assess include access and distance to toilets or toilet substitutes as well as ease when rising from beds or chairs. 
  • Social factors – areas to assess include living arrangements, the presence of care givers and to what degree care-givers are involved, influence of UI on their socialization. 
  • Bladder records – most commonly a seven day voiding diary which details the frequency, timing and amount of voids; amount of incontinence episodes; activities associated with UI and type/amount of fluid intake.

    B. Physical examination – guided by the medical history. Areas examined usually include:

  • General exam for assessment of edema and neurologic abnormalities.
  • Abdominal exam.
  • Rectal exam to assess perineal sensation, resting and active sphincter tone, fecal impaction, presence of masses and in men, the consistency and contour of the prostate.
  • Genital exam in men.
  • Pelvic exam in women to assess skin condition, genital atrophy, pelvic organ prolapse, pelvic masses, paravaginal muscle tone and any other abnormalities.
  • And if needed: Direct observation of urine loss by using cough stress test with full bladder; an estimation of post void residual volume; or urinalysis.

   5. The treatment plan will contain the goals of therapy, the exercise prescription, and measurable objectives.

   6. Individual progress notes will reflect the individualized activity, any instructions given, the patient’s response to the service and their progress toward stated goals of therapy.

Utilization Guidelines

In accordance with CMS Ruling 95-1 (V), utilization of these services should be consistent with locally acceptable standards of practice.

Compliance with the provisions in LCD L33615, Biofeedback may be monitored and addressed through post payment data analysis and subsequent medical review audits.

Coding Information

CPT/HCPCS Codes

Group 1

(1 Code)
Group 1 Paragraph

N/A

Group 1 Codes
CodeDescription
90901 BIOFEEDBACK TRAINING BY ANY MODALITY

Group 2

(2 Codes)
Group 2 Paragraph

N/A

Group 2 Codes
CodeDescription
90912 BIOFEEDBACK TRAINING, PERINEAL MUSCLES, ANORECTAL OR URETHRAL SPHINCTER, INCLUDING EMG AND/OR MANOMETRY, WHEN PERFORMED; INITIAL 15 MINUTES OF ONE-ON-ONE PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL CONTACT WITH THE PATIENT
90913 BIOFEEDBACK TRAINING, PERINEAL MUSCLES, ANORECTAL OR URETHRAL SPHINCTER, INCLUDING EMG AND/OR MANOMETRY, WHEN PERFORMED; EACH ADDITIONAL 15 MINUTES OF ONE-ON-ONE PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL CONTACT WITH THE PATIENT (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)

CPT/HCPCS Modifiers

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

(225 Codes)
Group 1 Paragraph

The following ICD-10-CM codes support medical necessity and provide limited coverage for CPT code: 90901.

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

Group 1 Codes
CodeDescription
G04.1 Tropical spastic paraplegia
G35 Multiple sclerosis
G81.00 Flaccid hemiplegia affecting unspecified side
G81.01 Flaccid hemiplegia affecting right dominant side
G81.02 Flaccid hemiplegia affecting left dominant side
G81.03 Flaccid hemiplegia affecting right nondominant side
G81.04 Flaccid hemiplegia affecting left nondominant side
G81.10 Spastic hemiplegia affecting unspecified side
G81.11 Spastic hemiplegia affecting right dominant side
G81.12 Spastic hemiplegia affecting left dominant side
G81.13 Spastic hemiplegia affecting right nondominant side
G81.14 Spastic hemiplegia affecting left nondominant side
G81.90 Hemiplegia, unspecified affecting unspecified side
G81.91 Hemiplegia, unspecified affecting right dominant side
G81.92 Hemiplegia, unspecified affecting left dominant side
G81.93 Hemiplegia, unspecified affecting right nondominant side
G81.94 Hemiplegia, unspecified affecting left nondominant side
G82.20 Paraplegia, unspecified
G82.21 Paraplegia, complete
G82.22 Paraplegia, incomplete
G82.50 Quadriplegia, unspecified
G82.51 Quadriplegia, C1-C4 complete
G82.52 Quadriplegia, C1-C4 incomplete
G82.53 Quadriplegia, C5-C7 complete
G82.54 Quadriplegia, C5-C7 incomplete
G83.0 Diplegia of upper limbs
G83.10 Monoplegia of lower limb affecting unspecified side
G83.11 Monoplegia of lower limb affecting right dominant side
G83.12 Monoplegia of lower limb affecting left dominant side
G83.13 Monoplegia of lower limb affecting right nondominant side
G83.14 Monoplegia of lower limb affecting left nondominant side
G83.20 Monoplegia of upper limb affecting unspecified side
G83.21 Monoplegia of upper limb affecting right dominant side
G83.22 Monoplegia of upper limb affecting left dominant side
G83.23 Monoplegia of upper limb affecting right nondominant side
G83.24 Monoplegia of upper limb affecting left nondominant side
G83.30 Monoplegia, unspecified affecting unspecified side
G83.31 Monoplegia, unspecified affecting right dominant side
G83.32 Monoplegia, unspecified affecting left dominant side
G83.33 Monoplegia, unspecified affecting right nondominant side
G83.34 Monoplegia, unspecified affecting left nondominant side
I67.89 Other cerebrovascular disease
M25.78 Osteophyte, vertebrae
M47.011 Anterior spinal artery compression syndromes, occipito-atlanto-axial region
M47.012 Anterior spinal artery compression syndromes, cervical region
M47.013 Anterior spinal artery compression syndromes, cervicothoracic region
M47.014 Anterior spinal artery compression syndromes, thoracic region
M47.015 Anterior spinal artery compression syndromes, thoracolumbar region
M47.016 Anterior spinal artery compression syndromes, lumbar region
M47.019 Anterior spinal artery compression syndromes, site unspecified
M47.021 Vertebral artery compression syndromes, occipito-atlanto-axial region
M47.022 Vertebral artery compression syndromes, cervical region
M47.029 Vertebral artery compression syndromes, site unspecified
M47.10 Other spondylosis with myelopathy, site unspecified
M47.11 Other spondylosis with myelopathy, occipito-atlanto-axial region
M47.12 Other spondylosis with myelopathy, cervical region
M47.13 Other spondylosis with myelopathy, cervicothoracic region
M47.14 Other spondylosis with myelopathy, thoracic region
M47.15 Other spondylosis with myelopathy, thoracolumbar region
M47.16 Other spondylosis with myelopathy, lumbar region
M47.20 Other spondylosis with radiculopathy, site unspecified
M47.21 Other spondylosis with radiculopathy, occipito-atlanto-axial region
M47.22 Other spondylosis with radiculopathy, cervical region
M47.23 Other spondylosis with radiculopathy, cervicothoracic region
M47.24 Other spondylosis with radiculopathy, thoracic region
M47.25 Other spondylosis with radiculopathy, thoracolumbar region
M47.26 Other spondylosis with radiculopathy, lumbar region
M47.27 Other spondylosis with radiculopathy, lumbosacral region
M47.28 Other spondylosis with radiculopathy, sacral and sacrococcygeal region
M47.811 Spondylosis without myelopathy or radiculopathy, occipito-atlanto-axial region
M47.812 Spondylosis without myelopathy or radiculopathy, cervical region
M47.813 Spondylosis without myelopathy or radiculopathy, cervicothoracic region
M47.814 Spondylosis without myelopathy or radiculopathy, thoracic region
M47.815 Spondylosis without myelopathy or radiculopathy, thoracolumbar region
M47.816 Spondylosis without myelopathy or radiculopathy, lumbar region
M47.817 Spondylosis without myelopathy or radiculopathy, lumbosacral region
M47.818 Spondylosis without myelopathy or radiculopathy, sacral and sacrococcygeal region
M47.819 Spondylosis without myelopathy or radiculopathy, site unspecified
M47.891 Other spondylosis, occipito-atlanto-axial region
M47.892 Other spondylosis, cervical region
M47.893 Other spondylosis, cervicothoracic region
M47.894 Other spondylosis, thoracic region
M47.895 Other spondylosis, thoracolumbar region
M47.896 Other spondylosis, lumbar region
M47.897 Other spondylosis, lumbosacral region
M47.898 Other spondylosis, sacral and sacrococcygeal region
M47.899 Other spondylosis, site unspecified
M47.9 Spondylosis, unspecified
M48.10 Ankylosing hyperostosis [Forestier], site unspecified
M48.11 Ankylosing hyperostosis [Forestier], occipito-atlanto-axial region
M48.12 Ankylosing hyperostosis [Forestier], cervical region
M48.13 Ankylosing hyperostosis [Forestier], cervicothoracic region
M48.14 Ankylosing hyperostosis [Forestier], thoracic region
M48.15 Ankylosing hyperostosis [Forestier], thoracolumbar region
M48.16 Ankylosing hyperostosis [Forestier], lumbar region
M48.17 Ankylosing hyperostosis [Forestier], lumbosacral region
M48.18 Ankylosing hyperostosis [Forestier], sacral and sacrococcygeal region
M48.19 Ankylosing hyperostosis [Forestier], multiple sites in spine
M48.20 Kissing spine, site unspecified
M48.21 Kissing spine, occipito-atlanto-axial region
M48.22 Kissing spine, cervical region
M48.23 Kissing spine, cervicothoracic region
M48.24 Kissing spine, thoracic region
M48.25 Kissing spine, thoracolumbar region
M48.26 Kissing spine, lumbar region
M48.27 Kissing spine, lumbosacral region
M48.30 Traumatic spondylopathy, site unspecified
M48.31 Traumatic spondylopathy, occipito-atlanto-axial region
M48.32 Traumatic spondylopathy, cervical region
M48.33 Traumatic spondylopathy, cervicothoracic region
M48.34 Traumatic spondylopathy, thoracic region
M48.35 Traumatic spondylopathy, thoracolumbar region
M48.36 Traumatic spondylopathy, lumbar region
M48.37 Traumatic spondylopathy, lumbosacral region
M48.38 Traumatic spondylopathy, sacral and sacrococcygeal region
M48.40XA Fatigue fracture of vertebra, site unspecified, initial encounter for fracture
M48.40XD Fatigue fracture of vertebra, site unspecified, subsequent encounter for fracture with routine healing
M48.40XG Fatigue fracture of vertebra, site unspecified, subsequent encounter for fracture with delayed healing
M48.40XS Fatigue fracture of vertebra, site unspecified, sequela of fracture
M48.41XA Fatigue fracture of vertebra, occipito-atlanto-axial region, initial encounter for fracture
M48.41XD Fatigue fracture of vertebra, occipito-atlanto-axial region, subsequent encounter for fracture with routine healing
M48.41XG Fatigue fracture of vertebra, occipito-atlanto-axial region, subsequent encounter for fracture with delayed healing
M48.41XS Fatigue fracture of vertebra, occipito-atlanto-axial region, sequela of fracture
M48.42XA Fatigue fracture of vertebra, cervical region, initial encounter for fracture
M48.42XD Fatigue fracture of vertebra, cervical region, subsequent encounter for fracture with routine healing
M48.42XG Fatigue fracture of vertebra, cervical region, subsequent encounter for fracture with delayed healing
M48.42XS Fatigue fracture of vertebra, cervical region, sequela of fracture
M48.43XA Fatigue fracture of vertebra, cervicothoracic region, initial encounter for fracture
M48.43XD Fatigue fracture of vertebra, cervicothoracic region, subsequent encounter for fracture with routine healing
M48.43XG Fatigue fracture of vertebra, cervicothoracic region, subsequent encounter for fracture with delayed healing
M48.43XS Fatigue fracture of vertebra, cervicothoracic region, sequela of fracture
M48.44XA Fatigue fracture of vertebra, thoracic region, initial encounter for fracture
M48.44XD Fatigue fracture of vertebra, thoracic region, subsequent encounter for fracture with routine healing
M48.44XG Fatigue fracture of vertebra, thoracic region, subsequent encounter for fracture with delayed healing
M48.44XS Fatigue fracture of vertebra, thoracic region, sequela of fracture
M48.45XA Fatigue fracture of vertebra, thoracolumbar region, initial encounter for fracture
M48.45XD Fatigue fracture of vertebra, thoracolumbar region, subsequent encounter for fracture with routine healing
M48.45XG Fatigue fracture of vertebra, thoracolumbar region, subsequent encounter for fracture with delayed healing
M48.45XS Fatigue fracture of vertebra, thoracolumbar region, sequela of fracture
M48.46XA Fatigue fracture of vertebra, lumbar region, initial encounter for fracture
M48.46XD Fatigue fracture of vertebra, lumbar region, subsequent encounter for fracture with routine healing
M48.46XG Fatigue fracture of vertebra, lumbar region, subsequent encounter for fracture with delayed healing
M48.46XS Fatigue fracture of vertebra, lumbar region, sequela of fracture
M48.47XA Fatigue fracture of vertebra, lumbosacral region, initial encounter for fracture
M48.47XD Fatigue fracture of vertebra, lumbosacral region, subsequent encounter for fracture with routine healing
M48.47XG Fatigue fracture of vertebra, lumbosacral region, subsequent encounter for fracture with delayed healing
M48.47XS Fatigue fracture of vertebra, lumbosacral region, sequela of fracture
M48.48XA Fatigue fracture of vertebra, sacral and sacrococcygeal region, initial encounter for fracture
M48.48XD Fatigue fracture of vertebra, sacral and sacrococcygeal region, subsequent encounter for fracture with routine healing
M48.48XG Fatigue fracture of vertebra, sacral and sacrococcygeal region, subsequent encounter for fracture with delayed healing
M48.48XS Fatigue fracture of vertebra, sacral and sacrococcygeal region, sequela of fracture
M48.50XA Collapsed vertebra, not elsewhere classified, site unspecified, initial encounter for fracture
M48.50XD Collapsed vertebra, not elsewhere classified, site unspecified, subsequent encounter for fracture with routine healing
M48.50XG Collapsed vertebra, not elsewhere classified, site unspecified, subsequent encounter for fracture with delayed healing
M48.50XS Collapsed vertebra, not elsewhere classified, site unspecified, sequela of fracture
M48.51XA Collapsed vertebra, not elsewhere classified, occipito-atlanto-axial region, initial encounter for fracture
M48.51XD Collapsed vertebra, not elsewhere classified, occipito-atlanto-axial region, subsequent encounter for fracture with routine healing
M48.51XG Collapsed vertebra, not elsewhere classified, occipito-atlanto-axial region, subsequent encounter for fracture with delayed healing
M48.51XS Collapsed vertebra, not elsewhere classified, occipito-atlanto-axial region, sequela of fracture
M48.52XA Collapsed vertebra, not elsewhere classified, cervical region, initial encounter for fracture
M48.52XD Collapsed vertebra, not elsewhere classified, cervical region, subsequent encounter for fracture with routine healing
M48.52XG Collapsed vertebra, not elsewhere classified, cervical region, subsequent encounter for fracture with delayed healing
M48.52XS Collapsed vertebra, not elsewhere classified, cervical region, sequela of fracture
M48.53XA Collapsed vertebra, not elsewhere classified, cervicothoracic region, initial encounter for fracture
M48.53XD Collapsed vertebra, not elsewhere classified, cervicothoracic region, subsequent encounter for fracture with routine healing
M48.53XG Collapsed vertebra, not elsewhere classified, cervicothoracic region, subsequent encounter for fracture with delayed healing
M48.53XS Collapsed vertebra, not elsewhere classified, cervicothoracic region, sequela of fracture
M48.54XA Collapsed vertebra, not elsewhere classified, thoracic region, initial encounter for fracture
M48.54XD Collapsed vertebra, not elsewhere classified, thoracic region, subsequent encounter for fracture with routine healing
M48.54XG Collapsed vertebra, not elsewhere classified, thoracic region, subsequent encounter for fracture with delayed healing
M48.54XS Collapsed vertebra, not elsewhere classified, thoracic region, sequela of fracture
M48.55XA Collapsed vertebra, not elsewhere classified, thoracolumbar region, initial encounter for fracture
M48.55XD Collapsed vertebra, not elsewhere classified, thoracolumbar region, subsequent encounter for fracture with routine healing
M48.55XG Collapsed vertebra, not elsewhere classified, thoracolumbar region, subsequent encounter for fracture with delayed healing
M48.55XS Collapsed vertebra, not elsewhere classified, thoracolumbar region, sequela of fracture
M48.56XA Collapsed vertebra, not elsewhere classified, lumbar region, initial encounter for fracture
M48.56XD Collapsed vertebra, not elsewhere classified, lumbar region, subsequent encounter for fracture with routine healing
M48.56XG Collapsed vertebra, not elsewhere classified, lumbar region, subsequent encounter for fracture with delayed healing
M48.56XS Collapsed vertebra, not elsewhere classified, lumbar region, sequela of fracture
M48.57XA Collapsed vertebra, not elsewhere classified, lumbosacral region, initial encounter for fracture
M48.57XD Collapsed vertebra, not elsewhere classified, lumbosacral region, subsequent encounter for fracture with routine healing
M48.57XG Collapsed vertebra, not elsewhere classified, lumbosacral region, subsequent encounter for fracture with delayed healing
M48.57XS Collapsed vertebra, not elsewhere classified, lumbosacral region, sequela of fracture
M48.58XA Collapsed vertebra, not elsewhere classified, sacral and sacrococcygeal region, initial encounter for fracture
M48.58XD Collapsed vertebra, not elsewhere classified, sacral and sacrococcygeal region, subsequent encounter for fracture with routine healing
M48.58XG Collapsed vertebra, not elsewhere classified, sacral and sacrococcygeal region, subsequent encounter for fracture with delayed healing
M48.58XS Collapsed vertebra, not elsewhere classified, sacral and sacrococcygeal region, sequela of fracture
M48.8X1 Other specified spondylopathies, occipito-atlanto-axial region
M48.8X2 Other specified spondylopathies, cervical region
M48.8X3 Other specified spondylopathies, cervicothoracic region
M48.8X4 Other specified spondylopathies, thoracic region
M48.8X5 Other specified spondylopathies, thoracolumbar region
M48.8X6 Other specified spondylopathies, lumbar region
M48.8X7 Other specified spondylopathies, lumbosacral region
M48.8X8 Other specified spondylopathies, sacral and sacrococcygeal region
M48.8X9 Other specified spondylopathies, site unspecified
M48.9 Spondylopathy, unspecified
M62.40 Contracture of muscle, unspecified site
M62.411 Contracture of muscle, right shoulder
M62.412 Contracture of muscle, left shoulder
M62.419 Contracture of muscle, unspecified shoulder
M62.421 Contracture of muscle, right upper arm
M62.422 Contracture of muscle, left upper arm
M62.429 Contracture of muscle, unspecified upper arm
M62.431 Contracture of muscle, right forearm
M62.432 Contracture of muscle, left forearm
M62.439 Contracture of muscle, unspecified forearm
M62.441 Contracture of muscle, right hand
M62.442 Contracture of muscle, left hand
M62.449 Contracture of muscle, unspecified hand
M62.451 Contracture of muscle, right thigh
M62.452 Contracture of muscle, left thigh
M62.459 Contracture of muscle, unspecified thigh
M62.461 Contracture of muscle, right lower leg
M62.462 Contracture of muscle, left lower leg
M62.469 Contracture of muscle, unspecified lower leg
M62.471 Contracture of muscle, right ankle and foot
M62.472 Contracture of muscle, left ankle and foot
M62.479 Contracture of muscle, unspecified ankle and foot
M62.48 Contracture of muscle, other site
M62.49 Contracture of muscle, multiple sites
M62.81 Muscle weakness (generalized)
M62.830 Muscle spasm of back
M62.831 Muscle spasm of calf
M62.838 Other muscle spasm

Group 2

(17 Codes)
Group 2 Paragraph

The following ICD-10-CM codes support medical necessity and provide limited coverage for CPT codes: 90912 and 90913

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

Group 2 Codes
CodeDescription
K59.00 Constipation, unspecified
K59.01 Slow transit constipation
K59.02 Outlet dysfunction constipation
K59.03 Drug induced constipation
K59.04 Chronic idiopathic constipation
K59.09 Other constipation
K59.4 Anal spasm
N36.42 Intrinsic sphincter deficiency (ISD)
N36.43 Combined hypermobility of urethra and intrinsic sphincter deficiency
N39.3 Stress incontinence (female) (male)
N39.46 Mixed incontinence
N39.490 Overflow incontinence
R15.0 Incomplete defecation
R15.1 Fecal smearing
R15.2 Fecal urgency
R15.9 Full incontinence of feces
R32 Unspecified urinary incontinence

ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

(1 Code)
Group 1 Paragraph

All those not listed under the “ICD-10 Codes that Support Medical Necessity” section of this article.

Group 1 Codes
CodeDescription
XX000 Not Applicable

ICD-10-PCS Codes

N/A

Additional ICD-10 Information

N/A

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

CodeDescription
999x Not Applicable

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

CodeDescription
99999 Not Applicable

Other Coding Information

N/A

Revision History Information

Revision History DateRevision History NumberRevision History Explanation
04/21/2023 R2

This article is being retired effective for dates of service on and after 04/06/2023 in response to the related LCD being retired.

01/01/2020 R1

Revision Number: 1
Publication: December 2019 Connection
LCR A/B2020-001

Explanation of Revision: Annual 2020 HCPCS Update. CPT code 90911 was deleted and replaced with CPT codes 90912 and 90913. The effective date of this revision is based on date of service.

Associated Documents

Related Local Coverage Documents
LCDs
L33615 - Biofeedback
Related National Coverage Documents
N/A
Statutory Requirements URLs
N/A
Rules and Regulations URLs
N/A
CMS Manual Explanations URLs
N/A
Other URLs
N/A
Public Versions
Updated On Effective Dates Status
04/21/2023 01/01/2020 - 04/06/2023 Retired You are here
12/16/2019 01/01/2020 - N/A Superseded View
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

N/A