S9002 — Intra-vaginal motion sensor system, provides biofeedback for pelvic floor muscle rehabilitation device
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- Use validated outcome measures to document whether a condition improves, worsens, and whether the magnitude of change is clinically significant
- Assess net health outcome as the balance of benefits and harms, including length of life, quality of life, and functional ability
- Document 20-minute pad test details (activities performed, bladder volume approximately 75%, pad collection/weight results)
- Documented diagnosis of stress, urgency, or mixed urinary incontinence.
Key Coverage Criteria
- Biofeedback therapy is consideredmedically necessarywhen the following criteria are met:
- Supervised by a physician or licensed practitioner;and
- Used as treatment for at least one of the following conditions:Cancer pain;orChronic back pain as part of a rehabilitation program;orChronic constipation;orFecal incontinence;orLevator ani syndrome, also known as anorectal pain syndrome;orMigraine or tension headaches;orUrinary incontinence.
- Cancer pain;or
- Chronic back pain as part of a rehabilitation program;or
- Chronic constipation;or
6 Active Policies
ANTHEM-CG-MED-97 — CG-MED-97 Biofeedback and Neurofeedback
BCBSIL-PSY301.016 — Biofeedback as a Treatment of Urinary Incontinence
BCBSMT-PSY301.016 — Biofeedback as a Treatment of Urinary Incontinence
BCBSNM-PSY301.016 — Biofeedback as a Treatment of Urinary Incontinence
BCBSOK-PSY301.016 — Biofeedback as a Treatment of Urinary Incontinence
Related Codes
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