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Coverage criteria policies

Biofeedback – medical applications

These services may or may not be covered by your HealthPartners plan. Please see your plan documents for your specific coverage information. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage.

Administrative Process

Prior authorization is not required for Biofeedback for medical applications.

Coverage

Biofeedback training is generally covered as part of a comprehensive treatment plan involving a member's primary care provider or specialist. Coverage is subject to the Indications listed below, and per your plan documents.

Indications that are covered

Medical applications of biofeedback are covered when received in an outpatient, medically supervised setting from a qualified clinician as part of a medical care plan.

While not an all- inclusive list, medical biofeedback application may be used for the following diagnoses:

  1. Headache (chronic, recurrent; migraine)
  2. Intractable musculoskeletal spasm
  3. Fecal incontinence
  4. Urinary incontinence (this could include treatment before or after surgeries for other diagnoses that cause urinary incontinence)
  5. Chronic constipation

Indications that are not covered

Although biofeedback training may be offered for other relaxation and self-regulation, it is considered experimental / investigative due to insufficient evidence. The following modalities are not covered:

  1. Neurotherapy biofeedback;
  2. Treatment of ordinary muscle tension states;
  3. Home biofeedback units are not covered because biofeedback is only covered when it is part of a comprehensive treatment plan involving a member's primary care physician or relevant specialist.

Definitions

Biofeedback is a training technique that uses electronic equipment to give information about one’s physiological state. Biofeedback therapy is used to complement other forms of therapy by providing visual, auditory, or other evidence of body functions, so that a person can be taught to exert voluntary control over functions which are otherwise involuntary. The goal is by being aware of the normal body functions; the person can be trained to alleviate an abnormal bodily condition.

Biofeedback therapy often uses electrical devices to transform body signals such as heart rate, blood pressure, skin temperature, salivation, and gross muscle tone into a light or a tone. This is displayed on a monitor or other device. Biofeedback therapy differs from electromyography, which is a diagnostic procedure to record and study the electrical properties of skeletal muscle. An electromyography device may be used to provide feedback with certain types of biofeedback.

Neurotherapy, also called neurofeedback, is a type of biofeedback that uses real-time displays of brain activity—most commonly electroencephalography (EEG), to teach self-regulation of brain function. Typically, sensors are placed on the scalp to measure activity, with measurements displayed using video displays or sound.

If available, codes are listed below for informational purposes only, and do not guarantee member coverage or provider reimbursement. The list may not be all-inclusive.

Codes

Description

90901

Biofeedback training by any modality

90911

Biofeedback training, perineal muscles, anorectal or urethral sphincter, including EMG and/or manometry

E0746

Electromyography (EMG), biofeedback device

CPT Copyright American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

Products

This information is for most, but not all, HealthPartners plans. Please read your plan documents to see if your plan has limits or will not cover some items. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage. These coverage criteria may not apply to Medicare Products if Medicare requires different coverage. For more information regarding Medicare coverage criteria or for a copy of a Medicare coverage policy, contact Member Services at 952-883-7979 or 1-800-233-9645.

References

  1. ECRI Institute. (2011). Biofeedback for Treatment of Fecal Incontinence. Plymouth Meeting, PA: ECRI Institute.
  2. Hayes, Inc. Hayes Medical Technology Directory Report. Electroencephalogram (EEG) Biofeedback Therapy. Lansdale, PA: Hayes, Inc.; April, 2003. Reviewed March, 2008/ Archived November 2008.
  3. Hooten, M., Thorson, D., Bianco, J, Bonte, B., Clavel Jr., A., Hora, J., … Walker, N. Institute for Clinical Systems Improvement. Pain: Assessment, non-opioid treatment approaches and opioid management. Updated August 2017.
  4. National Institute for Health and Care Excellence. (2013). Urinary incontinence in women: management. Clinical guideline (CG171).
  5. Rosenquist E. W. K. Overview of the treatment of chronic non-cancer pain. In: Up to Date, Aronson, M. D., & Park, L. (Eds). UpToDate, Waltham, MA. (Accessed on February 6, 2018.)
  6. Wald, A. Management of chronic constipation in adults. In: UpToDate, Talley, N. J., & Grover, S. (Eds), UpToDate, Waltham, MA. (Accessed on February 6, 2018.)

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Policy activity

  • 10/17/2000 - Date of origin
  • 02/01/2018 - Effective date
Review date
  • 02/2018

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