Biofeedback as a Treatment of Fecal Incontinence or Constipation

This policy covers biofeedback for adults with dyssynergia‑type functional constipation only when all three criteria are met: Rome IV symptom criteria, objective physiologic evidence of pelvic floor dyssynergia on manometry/EMG/imaging, and failure of a ≥3‑month trial of standard treatments. Coverage is limited to selected adults (up to six biofeedback sessions over three months), requires documentation excluding structural/endocrine/metabolic causes, and biofeedback is considered experimental/investigational for fecal incontinence, other constipation indications, and pediatric patients.

"Biofeedback for adults with dyssynergia-type functional constipation when ALL of the following are met: (1) symptoms meet Rome IV criteria; (2) objective physiologic evidence of pelvic floor dyssyn..."

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