Biofeedback - Is it Medically Necessary?
April 24th, 2019 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
Biofeedback is used for many reasons, and most commonly used for pain management. Each payer should be consulted with to verify coverage when treating with Biofeedback to verify if the treatment is considered experimental or investigational.
The majority of payers will list Biofeedback on an exclusions list. Others such as BC of SC may consider coverage if the treatment is deemed medically necessary for certain conditions. For example, BC OF SC POLICY CAM 20129 states the following,
"Biofeedback may be considered MEDICALLY NECESSARY as part of the overall treatment plan for migraine and tension-type headache."
Biofeedback for the treatment of cluster headache is considered INVESTIGATIONAL under most plans.
Unsupervised home use of biofeedback for treatment of headache is NOT MEDICALLY NECESSARY.
This policy only considers biofeedback as a treatment of headache.
Policy Guidelines
Biofeedback may require 10 to 20 office-based sessions of 30 to 60 minutes each.
Biofeedback is considered investigational for many of the conditions listed below and is commonly excluded from contracts and benefits. It is important to verify coverage with every payer.
- Psychotherapy
- Depression
- Hypertension
- Post-Traumatic Stress
- Motor dysfunction
- Movement disorders
- Multiple Sclerosis
- Chronic pain
- Other Misc. indications
Biofeedback may be considered medically necessary if supervised by a physician or licensed practitioner for the following conditions, according to Amerigroup Document # MED 00125.
Migraine or tension headaches; and
- Urinary incontinence; and
- Chronic constipation; and
- Fecal incontinence; and
- Levator ani syndrome, also known as anorectal pain syndrome; and
- Chronic back pain as part of a rehabilitation program; and
- Cancer pain.
Common codes related to Biofeedback
CPT - 90875, 90876, 90901
HCPCS - E0746 - Electromyography (emg), biofeedback device
This information was from Find-A-Code's Commercial Payer Policy tool, where you can find medical necessity, exclusions and rational on over 80 payer policies. In addition, be sure to consult your Local Carrier Determinations (LCDs) from your Medicare carrier.
###
Questions, comments?
If you have questions or comments about this article please contact us. Comments that provide additional related information may be added here by our Editors.
Latest articles: (any category)
Artificial Intelligence in Healthcare - A Medical Coder's PerspectiveDecember 26th, 2023 - Aimee WilcoxWe constantly hear how AI is creeping into every aspect of healthcare but what does that mean for medical coders and how can we better understand the language used in the codeset? Will AI take my place or will I learn with it and become an integral part of the process that uses AI to enhance my abilities?
Specialization: Your Advantage as a Medical Coding ContractorDecember 22nd, 2023 - Find-A-CodeMedical coding contractors offer a valuable service to healthcare providers who would rather outsource coding and billing rather than handling things in-house. Some contractors are better than others, but there is one thing they all have in common: the need to present some sort of value proposition in order to land new clients. As a contractor, your value proposition is the advantage you offer. And that advantage is specialization.
ICD-10-CM Coding of Chronic Obstructive Pulmonary Disease (COPD)December 19th, 2023 - Aimee WilcoxChronic respiratory disease is on the top 10 chronic disease list published by the National Institutes of Health (NIH). Although it is a chronic condition, it may be stable for some time and then suddenly become exacerbated and even impacted by another acute respiratory illness, such as bronchitis, RSV, or COVID-19. Understanding the nuances associated with the condition and how to properly assign ICD-10-CM codes is beneficial.
Changes to COVID-19 Vaccines Strike AgainDecember 12th, 2023 - Aimee WilcoxAccording to the FDA, CDC, and other alphabet soup entities, the old COVID-19 vaccines are no longer able to treat the variants experienced today so new vaccines have been given the emergency use authorization to take the place of the old vaccines. No sooner was the updated 2024 CPT codebook published when 50 of the codes in it were deleted, some of which were being newly added for 2024.
Updated ICD-10-CM Codes for AppendicitisNovember 14th, 2023 - Aimee WilcoxWith approximately 250,000 cases of acute appendicitis diagnosed annually in the United States, coding updates were made to ensure high-specificity coding could be achieved when reporting these diagnoses. While appendicitis almost equally affects both men and women, the type of appendicitis varies, as dose the risk of infection, sepsis, and perforation.
COVID Vaccine Coding Changes as of November 1, 2023October 26th, 2023 - Wyn StaheliCOVID vaccine changes due to the end of the PHE as of November 1, 2023 are addressed in this article.
Medicare Guidance Changes for E/M ServicesOctober 11th, 2023 - Wyn Staheli2023 brought quite a few changes to Evaluation and management (E/M) services. The significant revisions as noted in the CPT codebook were welcome changes to bring other E/M services more in line with the changes that took place with Office or Other Outpatient Services a few years ago. As part of CMS’ Medicare Learning Network, the “Evaluation and Management Services Guide” publication was finally updated as of August 2023 to include the changes that took place in 2023. If you take a look at the new publication (see references below),....
