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
