Biofeedback Procedures Guidelines

CPT Code History & Guidelines

There are three CPT codes are available,

• 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)

The CPT 90911 was deleted in 2022 and the CPT 90912 & +90913 was added in Jan'2020. The purpose of this codes added,

The provider or other qualified healthcare professional will be trained the patients to control of involuntary bodily functions. There are,

• Altering brain activity,
• Blood pressure,
• Heart rate, and
• Other bodily functions that the patient cannot normally control voluntarily.

This service is done for conditions such as fecal or urinary incontinence. EMG and manometry, if performed, are included with this service.

• The CPT 90912 can reported for the first 15 minutes of face–to–face service with the patients, and 
• The CPT 90913 can be reported for each additional 15 minutes of face–to–face biofeedback training with the patient.
  

 

Clinical View

The physician uses the equipment that measures and responds to very slight changes in the body, such as changes in temperature, heart rate, blood pressure, and muscle tension, and provides feedback to the patient via lights, sounds, and meters.

And by using this equipment, and other therapeutic methods, the provider guides the patient through practices to alter his bodily functions and learn to control his reactions to help treat his disorders.

In this service, the provider is usually a urologist who first assesses and documents that reasons why the patient is a good candidate for biofeedback.

The provider then uses biofeedback–assisted pelvic muscle education (PME) which may include measurement of muscle contraction through an electromyography (EMG) and vaginal or rectal sensors and/or rectal manometry devices to help the patient become more aware of the pelvic muscles and assist in their movement.

The service may also include other techniques, such as relaxation, to help control involuntary bodily movements.

After completion of the test, the providers will take the printouts from the testing and his/her written interpretation of each of the tests in the patient’s medical record.

Limitation and Frequency

The Biofeedback sessions often have limits of four to six treatments over a four–week period. If it's exceeded as a result, payers will deny claims that exceed the frequency limit unless you can prove that the patient's specific condition requires additional services.

Payer Specific Updates

Some payers still consider biofeedback bladder training to be experimental and investigational services.

BCBS Updates

 

Covered ICD Codes

The listed below diagnosis are considered as the medical necessity

• G44.201 Tension-type headache, unspecified, intractable
• G44.209 Tension-type headache, unspecified, not intractable
• G44.211 Episodic tension-type headache, intractable
• G44.219 Episodic tension-type headache, not intractable
• G44.221 Chronic tension-type headache, intractable
• G44.229 Chronic tension-type headache, not intractable
• G43.001 Migraine without aura, not intractable, with status migrainosus
• G43.009 Migraine without aura, not intractable, without status migrainosus
• G43.011 Migraine without aura, intractable, with status migrainosus
• G43.019 Migraine without aura, intractable, without status migrainosus
• G43.101 Migraine with aura, not intractable, with status migrainosus
• G43.109 Migraine with aura, not intractable, without status migrainosus
• G43.111 Migraine with aura, intractable, with status migrainosus
• G43.119 Migraine with aura, intractable, without status migrainosus
• G43.401 Hemiplegic migraine, not intractable, with status migrainosus
• G43.409 Hemiplegic migraine, not intractable, without status migrainosus
• G43.411 Hemiplegic migraine, intractable, with status migrainosus
• G43.419 Hemiplegic migraine, intractable, without status migrainosus
• G43.501 Persistent migraine aura without cerebral infarction, not intractable, with status migrainosus
• G43.509 Persistent migraine aura without cerebral infarction, not intractable, without status migrainosus
• G43.511 Persistent migraine aura without cerebral infarction, intractable, with status migrainosus
• G43.519 Persistent migraine aura without cerebral infarction, intractable, without status migrainosus
• G43.601 Persistent migraine aura with cerebral infarction, not intractable, with status migrainosus
• G43.609 Persistent migraine aura with cerebral infarction, not intractable, without status migrainosus
• G43.611 Persistent migraine aura with cerebral infarction, intractable, with status migrainosus
• G43.619 Persistent migraine aura with cerebral infarction, intractable, without status migrainosus
• G43.701 Chronic migraine without aura, not intractable, with status migrainosus
• G43.709 Chronic migraine without aura, not intractable, without status migrainosus
• G43.711 Chronic migraine without aura, intractable, with status migrainosus
• G43.719 Chronic migraine without aura, intractable, without status migrainosus
• G43.801 Other migraine, not intractable, with status migrainosus
• G43.809 Other migraine, not intractable, without status migrainosus
• G43.811 Other migraine, intractable, with status migrainosus
• G43.819 Other migraine, intractable, without status migrainosus
• G43.821 Menstrual migraine, not intractable, with status migrainosus
• G43.829 Menstrual migraine, not intractable, without status migrainosus
• G43.831 Menstrual migraine, intractable, with status migrainosus
• G43.839 Menstrual migraine, intractable, without status migrainosus
• G43.901 Migraine, unspecified, not intractable, with status migrainosus
• G43.909 Migraine, unspecified, not intractable, without status migrainosus
• G43.911 Migraine, unspecified, intractable, with status migrainosus
• G43.919 Migraine, unspecified, intractable, without status migrainosus
• G89.3 Neoplasm related pain (acute) (chronic)
• 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
• N39.3 Stress incontinence (female) (male)
• N39.41 Urge incontinence
• 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

Modifier

• Some payers may require modifier GP, Services delivered under an outpatient physical therapy plan of care.

Experimental or investigational

Biofeedback is considered experimental or investigational for treatment of all other conditions, including but not limited to

• Anxiety disorders
• Asthma
• Bell palsy
• Chronic pain (including but not limited to low back pain)
• Cluster headache
• Depression
• Functional urinary incontinence
• Hypertension
• Insomnia
• Mechanical urinary incontinence
• Movement disorders, such as motor function after stroke, injury, or lower-limb surgery
• Multiple sclerosis
• Orthostatic hypotension in patients with spinal cord injury
• Pain management during labor
• Post-traumatic stress disorder
• Prevention of preterm birth
• Psychosomatic conditions
• Raynaud’s disease
• Sleep bruxism
• Tinnitus
• Vaginismus
• Vulvodynia

BCBS Updates to Billing CPT 99080 & 99499

The Centers for Medicare and Medicaid services are allowed to submit claims with 12 diagnoses in CMS 1500 form.

However, some of the practice management systems will limit the diagnoses to fewer than 12 diagnoses.

If any practice management system limits the number of diagnoses to fewer than 12 and the supplemental claims can be submitted with E&M Codes with $ 0.01 or $0.00 based on whether the system allows it. 

 

Billing and Coding Guidelines

 

The simple question is, how to capture all the diagnosis and billed it out to Florida Blue Insurance?. 

 

Submit a second line item with CPT 99080 other than the first 12 diagnoses. Initially, the BCBS accepted only CPT 99080 for additional diagnoses but now, the BCBS insurance will allow to bill CPT 99499 as well for the additional diagnoses. 

The BCBS can accept a zero-dollar charge ($0.00), or a penny charge ($0.01) if your system does not allow zero-dollar charges. 

 

If the claim is electronic, use frequency code “0.” This code will deny as incidental to the procedure code submitted on the primary claim and no payment will be applied. 

 

Billing with a penny charge needs no reconciliation on the outstanding balance for providers.

Use at least one clinical diagnoses code from the original claim in first position and all other additional ICD 10 CM codes in position 2 to 12. 

 

The billed all the diagnoses must be documented in the medical record and they should be supported as per the CMS guidelines. 

The supplemental claims must be submitted within 180 days from the original E&M services. 

 

If you have a capitated payment arrangement, do not submit date-span claims for office services (Place of Service 11).

The CMS may requires documentation, diagnosis coding, and claims submissions to align to each individual date of service and face-to-face encounter for the review. 

Please do not submit a corrected claim Frequency Type 7 or Type 8. A corrected claim Type 7 tells Florida Blue the original claim was wrong, and a Type 8 claim will void or cancel the original claim.

Golden Rule - Pulse Oximetry with Evaluation & Management

CPT Code Description: -

94760 - Noninvasive ear or pulse oximetry for oxygen saturation; single determination

94761 - Noninvasive ear or pulse oximetry for oxygen saturation; multiple determinations (e.g., during exercise) 

The provider and or other qualified healthcare professional takes the oxygen saturation using the a sensor on the ear or finger from the patients.

To perform this service, the doctor places a sensor, such as one in the form of a clip, on the patient’s earlobe or fingertip.

The sensor uses a light shining through the body part to measure the oxygen saturation, detecting the differences in the ways blood cells with and without oxygen reflect light.
 

The Oxygen saturation, is also called as O2 sat, and the percentage of hemoglobin carrying oxygen molecules.

 

Guidelines: -

The CPT Codes ranges from 94010 to 94799 include laboratory procedure(s) and interpretation of test results.

If a separate identifiable evaluation and management service is performed on the same day, the appropriate E/M service code can be billed separately. Like,

• New or Established Patient Office or Other Outpatient Services (99202 to 99215),
• Office or Other Outpatient Consultations (99242 to 99245),
• Emergency Department Services (99281 to 99285),
• Nursing Facility Services (99304 to 99316),
• Home or Residence Services (99341 to 99350),

The mentioned above listed CPT codes may be reported with modifier 25 based on the NCCI edits guidelines in addition to the 94010-94799.

General Information: -

The pulse oximetry codes are not reportable with any other service performed on the same day.

There is no NCCI edits for this CPT codes, but as per the CMS guidelines, the Medicare Physician as categorized into the "T" status code, which means they are only paid if there are no other services payable under the physician fee schedule billed on the same date by the same provider.

Additional Information: -

Pulmonary function tests (94011-94013) are reported for measurements in infants and young children through 2 years of age.

Pulmonary function testing measurements are reported as actual values and as a percent of predicted values by age, gender, height, and race.

CMS Unveils Surprise-Billing Rules

Proposed Billing Rules 2022

CMS unveiled July 2 the first in a series of rules aimed at shielding patients from surprise billing. The interim final rule addresses several provisions in the No Surprises Act passed by Congress last year.

Most provisions outlined in the proposed rule will not take effect until Jan. 1, 2022. 

Ten things to know,

1. Bans surprise billing for emergency services

• The interim final rule bans surprise billing for emergency services, regardless of where they are provided. 
• Providers are required to bill emergency services on an in-network basis without prior authorization.

2. Bans high out-of-network cost-sharing for emergency and non-emergency services 

• CMS proposed that patient cost-sharing, including coinsurance and deductibles, be based on in-network provider rates. 
• This means that cost-sharing can't be higher than if the services were provided by an in-network physician. 

3. Bans surprise billing for ancillary services and any "others." 

• The interim final rule prohibits out-of-network charges for ancillary care in in-network facilities in all instances. This includes anesthesiology services. 
• CMS said that it also includes a ban on any other out-of-network charges to patients without notice. 

4. Interim payment or notice of denial from insurers. 

• The interim final rule would require health plans to make an initial payment or issue a notice of denial to providers in 30 days after it receives a clean claim. 

5. Consent process to waive balance-billing protections. 

• The law allows patients to waive their balance-billing protections and consent to out-of-network charges. 
• The rule directs the departments to establish a process to obtain patient consent for balance billing. Providers can't use this for emergency services or some ancillary services.

6. Providers must disclose balance-billing protections. 

• Providers will be required to post publicly to inform patients about their surprise-billing protections.

7. Qualifying payment amount. 

• CMS defined the qualifying payment amount, which will calculate patient cost-sharing and be used by an arbiter in the independent dispute resolution process, as the issuer's median in-network rate for 2019 trended forward. 
• The rule addresses several factors that will determine how the rates are set, including the type of contract, insurance market, geographic region, and rates for the same or similar services. 

8. Complaint process. 

• Through the proposed rule, CMS will establish a process for which patients and others can submit complaints about violations of the balance-billing requirements. 

9. Arbitration process. 

• The first interim rule doesn't discuss the dispute resolution process. 

10. Comment period. 

• Providers will have 60 days to comment on the interim final rule.