Pelvic Floor Dysfunction Treatment Coverage

by  Wyn Staheli, Director of Research
October 16th, 2018

Pelvic floor dysfunction is often the underlying cause of conditions such as pelvic pain; urinary or bowel dysfunction; and/or sexual symptoms. Treatment generally begins with an evaluation and testing (e.g, EMG) followed by a variety of services (e.g., biofeedback, manipulation, pelvic floor electrical stimulation), depending on the findings.

Coverage by payers varies greatly depending on individual policies and the services provided as well as the diagnosis. Be sure to verify coverage before providing these services.

To illustrate these differences, the following policies can provide additional guidance:

• BC/BS of RI Medical Coverage Policy
• BC/BS of RI Medical Policy
• CMS Decision Memo
• Noridian PDAC Code Review
• Well Sense Health Plan Medical Policy

Note: Review the "Commercial Payer Policies" tab, available by subscription in FindaCode.com, at the code level to review associated payer policies and individual coverage information.

References:

• Physical Therapy Evaluation CPT Codes and the Womens Health Therapist
• National Coverage Determination (NCD) for Biofeedback Therapy for the Treatment of Urinary Incontinence