Article - Billing and Coding: Outpatient Therapy Biofeedback Training (A53352)

CMS National Coverage PolicyN/AArticle TextThe 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.CPTcode 90901 or 90912 or 90913 should beas appropriatebilled 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 1Treatment=60 MinutesTreatmentBiofeedback Training= 60 minutesTherapeutic Exercises while on Biofeedback Modality and Electrical stimulationBillBiofeedback Training one (1) unitExample 2Treatment=60 MinutesTreatmentBiofeedback Training= 45 minutesTherapeutic Exercises without Biofeedback Training-15 minutesBillBiofeedback Training= one (1) unitTherapeutic Exercises=one (1) unitTreatment for Urinary IncontinenceMedicare 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 exercisesduring the same15 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 1Treatment=60 MinutesTreatmentBiofeedback Training= 60 minutesElectrical Stimulation= 15 minutesTherapeutic Exercises while on Biofeedback Modality and Electrical stimulationBillBiofeedback Training one (1) unitExample 2Treatment=60 MinutesTreatmentBiofeedback Training= 45 minutesElectrical Stimulation while on Biofeedback Modality= 15minutesTherapeutic Exercises without Biofeedback or Electrical Stimulation = 15 minutesBillBiofeedback Training= one (1) unitTherapeutic Exercises= one (1) unitExample 3Treatment=60 MinutesTreatmentBiofeedback Training= 45 minutesElectrical Stimulation while not on Biofeedback Modality= 15minutesTherapeutic Exercises during same 15 minute intervalBillBiofeedback Training= one (1) unitTherapeutic Exercises (or attended Electrical Stimulation)= one (1) unitSourcesCMS Internet Only Manual (IOM) National Coverage Determinations (NCD) Manual, Publication 100-03, Chapter 1, Sections 30.1 and 30.1.1CMS IOM National Coverage Determinations (NCD) Manual, Publication 100-03, Chapter 1, Section 160.12CMS IOM Medicare Claims Processing Manual, Publication 100-04, Chapter 5, Section 20(B)