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Viewing:  May 22, 2019

Biofeedback - Is it Medically Necessary?

By:  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 - E0746Electromyography (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.


References:

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