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A.2.01.27
Biofeedback is a technique to teach individuals self-regulation of physiologic processes not generally considered to be under voluntary control; a variety of approaches and devices are available. Biofeedback, in conjunction with pelvic floor muscle training, is proposed as a treatment of urinary incontinence.
BiofeedbackBiofeedback is intended to teach individuals self-regulation of certain physiologic processes not normally considered to be under voluntary control. The technique involves feedback on a variety of types of information not commonly available to the individual, followed by a concerted effort on the part of the individual to use this feedback to help alter the physiologic process in some specific way. Biofeedback has been proposed as a treatment for a variety of diseases and disorders, including anxiety, headaches, hypertension, movement disorders, incontinence, pain, asthma, Raynaud disease, and insomnia. Biofeedback training is done either in individual or group sessions and as a single therapy or in combination with other therapies designed to teach relaxation. A typical program consists of 10 to 20 training sessions of 30 minutes each. Training sessions are performed in a quiet, non-arousing environment. Subjects are instructed to use mental techniques to affect the physiologic variable monitored, and feedback is provided for the successful alteration of the physiologic parameter. This feedback may be in the form of signals, such as lights or tone, verbal praise, or other auditory or visual stimuli.
Biofeedback, in conjunction with pelvic floor muscle training, is a possible treatment modality for stress, urge, mixed, and overflow urinary incontinence because it may enhance awareness of body functions and the learning of exercises to train pelvic muscles. Several proposed biofeedback methods that may be employed to treat urinary incontinence, including vaginal cones or weights, perineometers, and electromyographic systems with vaginal and rectal sensors.
The various forms of biofeedback mainly differ in the nature of the disease or disorder under treatment, the biologic variable that the subject attempts to control, and the information that is fed back to the subject. Biofeedback techniques include peripheral skin temperature feedback, blood-volume-pulse feedback (vasoconstriction and dilation), vasoconstriction training (temporalis artery), and electromyographic biofeedback; they may be used alone or in conjunction with other therapies (e.g., relaxation, behavioral management, medication).
A variety of biofeedback devices have been cleared for marketing by the U.S. Food and Drug Administration (FDA) through the 510(k) process. The FDA defines a biofeedback device as “an instrument that provides a visual or auditory signal corresponding to the status of one or more of a patient's physiological parameters (e.g., brain alpha wave activity, muscle activity, skin temperature, etc.) so that the patient can control voluntarily these physiological parameters."
The leva® Pelvic Heath system uses motion sensor technology to provide biofeedback through use of an intravaginal device worn pelvic during training with connection to a smartphone app. The device received FDA approval in 2022 for fecal incontinence, urinary incontinence, and strengthening of the pelvic muscle floor.
Other indications for Biofeedback are addressed in a separate policy .
Biofeedback is considered investigational as a treatment of urinary incontinence in adults.
Federal Employee Program (FEP) may dictate that all FDA-approved devices, drugs or biologics may not be considered investigational and thus these devices may be assessed only on the basis of their medical necessity.
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language.
Investigative is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized as a generally accepted standard of good medical practice for the treatment of the condition being treated and; therefore, is not considered medically necessary. For the definition of Investigative, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of medical practitioners practicing in relevant clinical areas and any other relevant factors. In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting.
9/24/2009: Policy added to address biofeedback specifically for urinary incontinence.
07/15/2010: Policy description and statement unchanged. FEP verbiage added to the Policy Exceptions section.
09/25/2012: Policy reviewed; no changes.
10/23/2013: Policy description re-arranged for clarity purposes. No changes to policy statement.
09/10/2014: Policy reviewed; no changes.
08/25/2015: Code Reference section updated for ICD-10. Removed ICD-9 procedure codes 89.21, 89.23, and 93.08.
01/05/2016: Policy description updated. Policy statement unchanged. Investigative definition updated in policy guidelines section.
06/01/2016: Policy number A.2.01.27 added.
01/26/2017: Policy reviewed; no changes.
05/23/2018: Link updated in policy description.
08/21/2018: Policy description updated. Policy statement unchanged.
09/04/2019: Policy description updated to remove information regarding urinary incontinence and treatment. Policy statement unchanged.
12/19/2019: Code Reference section updated to add new CPT codes 90912 and 90913 effective 01/01/2020.
09/08/2020: Policy reviewed; no changes.
12/07/2021: Policy reviewed. Policy statement unchanged. Code Reference section updated to remove deleted CPT code 90911.
09/07/2022: Policy reviewed; no changes.
09/08/2023: Policy description updated. Policy statement unchanged.
12/12/2024: Policy description updated regarding devices. Policy statement unchanged.
Blue Cross Blue Shield Association Policy # 2.01.27
This may not be a comprehensive list of procedure codes applicable to this policy.
Investigational Codes
Code Number | Description | ||
CPT-4 | |||
90875, 90876 | Individual psychophysiological therapy incorporating biofeedback training by any modality (face-to-face with the patient), with psychotherapy (e.g., insight oriented, behavior modifying, or supportive psychotherapy); code range | ||
90901 | Biofeedback training by any modality | ||
90912 | Biofeedback training, perineal muscles, anorectal or urethral sphincter, including EMG and/or manometry, when performed; initial 15 minutes of one-on-one physician or other qualified health care professional contact with the patient | ||
90913 | Biofeedback training, perineal muscles, anorectal or urethral sphincter, including EMG and/or manometry, when performed; each additional 15 minutes of one-on-one physician or other qualified health care professional contact with the patient (List separately in addition to code for primary procedure) | ||
HCPCS | |||
E0746 | Electromyography (EMG), biofeedback device | ||
ICD-9 Procedure | ICD-10 Procedure | ||
94.39 | Other individual psychotherapy (biofeedback) | GZC9ZZZ | Biofeedback |
ICD-9 Diagnosis | ICD-10 Diagnosis |
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