Outpatient Therapy Biofeedback Training

The amount of time the therapist 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 should be 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.

Biofeedback Training Examples

Example 1

Treatment = 60 Minutes

Treatment
Biofeedback Training = 60 minutes
Therapeutic Exercises while on Biofeedback Training = 15 minutes

Bill
Biofeedback Training (90901) = 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 90911) 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 (90901or 90911) = one (1) unit

Example 2

Treatment = 60 Minutes

Treatment
Biofeedback Training = 45 minutes
Electrical Stimulation while on Biofeedback Modality = 15 minutes
Therapeutic Exercises without Biofeedback or Electrical Stimulation = 15 minutes

Bill
Biofeedback Training = one (1) unit
Therapeutic Exercises = one (1) unit

Example 3

Treatment = 60 Minutes

Treatment
Biofeedback Training = 45 minutes
Electrical Stimulation while not on Biofeedback Modality = 15 minutes
Therapeutic Exercises during same 15 minute interval

Bill
Biofeedback Training = one (1) unit
Therapeutic Exercises (or attended Electrical Stimulation) = one (1) unit

Resources

 

Last Updated Mon, 01 Mar 2021 14:26:46 +0000