Local Coverage Article Billing and Coding

Billing and Coding: Outpatient Therapy Biofeedback Training

A52755

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Contractor Information

Article Information

General Information

Article ID
A52755
Article Title
Billing and Coding: Outpatient Therapy Biofeedback Training
Article Type
Billing and Coding
Original Effective Date
10/01/2015
Revision Effective Date
01/01/2020
Revision Ending Date
N/A
Retirement Date
N/A
AMA CPT / ADA CDT / AHA NUBC Copyright Statement

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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.

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CMS National Coverage Policy

N/A

Article Guidance

Article Text

The amount of time the therapist, physician, or non-physician practitioner (NPP) spends working with a patient must be accurately documented in the medical record to support the units billed on a claim (for both untimed and time-based code services). Providers should be aware of the provision and billing requirements for each Current Procedural Terminology (CPT®) code billed.

CPT® code 90901 or 90912 or 90913 should be as appropriate billed when biofeedback training is provided. Biofeedback training consists of the amount of time that the biofeedback modality is attached to the patient with the feedback results to be used and/or analyzed by the patient and/or clinician. Separate billing for concurrently applied modalities and/or procedures during biofeedback training is not appropriate. For example, a therapist may provide a combination of biofeedback and therapeutic exercises during the same 15 minutes to treat a patient. In these instances, the therapeutic exercises are considered to be a component of the biofeedback training and should not be separately billed. Providers should only bill the appropriate biofeedback training code for these combined services.

Example 1

Treatment=60 Minutes

 

Treatment

Biofeedback Training= 60 minutes

 

Therapeutic Exercises while on Biofeedback Modality and Electrical stimulation

Bill

Biofeedback Training one (1) unit

 

Example 2

Treatment=60 Minutes

Treatment

Biofeedback Training= 45 minutes

 

Therapeutic Exercises without Biofeedback Training-15 minutes

Bill

Biofeedback Training= one (1) unit

 

Therapeutic Exercises=one (1) unit

 

Treatment for Urinary Incontinence

Medicare covers biofeedback for the treatment of stress and/or urge incontinence in cognitively intact patients 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 prescribed plan of PME. Medical record documentation of the failed PME trial must be present to justify coverage for biofeedback.

When biofeedback training is provided, the most appropriate biofeedback code (90901 or 90912 or 90913) should be billed. Similarly, separate billing for concurrently applied modalities and/or procedures during biofeedback training is not appropriate. For example, a therapist may provide a combination of neuromuscular electrical stimulation (NMES), biofeedback, and therapeutic exercises during the same 15 minutes to treat a patient with urinary incontinence. In these instances, the therapeutic exercises and the NMES are considered to be a component of the biofeedback training and should not be billed separately. Providers should only bill the appropriate biofeedback training code for these combined services.

 

Example 1

Treatment=60 Minutes

Treatment

Biofeedback Training= 60 minutes

 

Electrical Stimulation= 15 minutes

 

Therapeutic Exercises while on Biofeedback Modality and Electrical stimulation

Bill

Biofeedback Training one (1) unit

 

Example 2

Treatment=60 Minutes

Treatment

Biofeedback Training= 45 minutes

 

Electrical Stimulation while on Biofeedback Modality= 15minutes

 

Therapeutic Exercises without Biofeedback or Electrical Stimulation = 15 minutes

Bill

Biofeedback Training= one (1) unit

 

Therapeutic Exercises= one (1) unit

 

Example 3

Treatment=60 Minutes

Treatment

Biofeedback Training= 45 minutes

 

Electrical Stimulation while not on Biofeedback Modality= 15minutes

 

Therapeutic Exercises during same 15 minute interval

Bill

Biofeedback Training= one (1) unit

 

Therapeutic Exercises (or attended Electrical Stimulation)= one (1) unit

Sources

  • CMS Internet Only Manual (IOM) National Coverage Determinations (NCD) Manual, Publication 100-03, Chapter 1, Sections 30.1 and 30.1.1
  • CMS IOM National Coverage Determinations (NCD) Manual, Publication 100-03, Chapter 1, Section 160.12
  • CMS IOM Medicare Claims Processing Manual, Publication 100-04, Chapter 5, Section 20(B)

Coding Information

CPT/HCPCS Codes

Group 1

(3 Codes)
Group 1 Paragraph

N/A

Group 1 Codes
CodeDescription
90901 BIOFEEDBACK TRAINING BY ANY MODALITY
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

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ICD-10-CM Codes that Support Medical Necessity

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

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Additional ICD-10 Information

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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.

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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.

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Other Coding Information

N/A

Revision History Information

Revision History DateRevision History NumberRevision History Explanation
01/01/2020 R3

Converted article to a Billing and Coding article.

Add ‘physician and NPP’ to the qualified provider as per CPT® described as “sometimes” therapy codes, which can be provided by physician/NPP outside a therapy plan of care and to ensue the article encompasses both Part A and Part B.

Deleted codes in the examples.

Added CMS IOM Medicare Claims Processing Manual, Publication 100-04, Chapter 5, Section 20(B) under Sources.

08/06/2018 R2

This final article effective 8/6/2018, combines JFA A52755 into the JFB A53346 article so that both JFA and JFB contract numbers will have the same final Medicare Coverage Database (MCD) article number A52755.

10/01/2015 R1 This article was revised to update language and structure. No coverage changes were made.

Associated Documents

Related Local Coverage Documents
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Related National Coverage Documents
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Statutory Requirements URLs
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Rules and Regulations URLs
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CMS Manual Explanations URLs
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Other URLs
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Public Versions
Updated On Effective Dates Status
11/06/2020 01/01/2020 - N/A Currently in Effect You are here
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

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