Article Detail - JA DME

Original Effective Date: 10/01/2001
Revision Effective Date: 11/01/2013

In a recent national coverage determination published in the Medicare Coverage Issues Manual, Section 35-27.1, coverage criteria are defined for biofeedback therapy for the treatment of urinary incontinence. The policy specifies that coverage can be considered when the therapy is rendered by a practitioner in an office or other facility setting. The policy specifically states that home use of biofeedback therapy for urinary incontinence is not covered. Biofeedback devices for home use for the treatment of urinary incontinence will be denied as not medically necessary.

If these devices are provided for home use, they must be billed to the DMERC using code E1399 - durable medical equipment, miscellaneous. The claim should include the manufacturer and brand name/number of the device and information describing the condition for which it is being used. This information should be entered in the HA0 record of an electronic claim or attached to a paper claim.

Physicians and suppliers should refer to information published by their local carriers and intermediaries for details concerning coding and coverage of biofeedback therapy in the office or other facility setting.

Medicare does cover home use of non-implantable pelvic floor electrical stimulators (PFES) for the treatment of urinary incontinence. See the article in the Spring 2001 Region D DMERC Dialogue for additional information about PFES devices.