Billing and Coding: Outpatient Therapy Biofeedback Training
A52755
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 <table style="border-collapse: collapse; height: 323px;" border="1" cellspacing="0" cellpadding="0"