Billing and Coding: Outpatient Therapy Biofeedback Training

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)