CPT Code Updates

Thank you all for submitting questions pertaining to our recent blog post:  Biofeedback and Dry Needling Code Update. Below are answers to many of your asked questions. if you have any additional questions, please do reach out to the Academy of Pelvic Health Physical Therapy’s Director of Practice, Kim Parker-Guerrero, PT, DPT at practice@aptapelvichealth.org.

NEW BIOFEEDBACK CODES – replaced CPT code 90911

• CPT code 90912 – Biofeedback training, perineal muscles, anorectal or urethral sphincter, including electromyography (EMG) and/or manometry, when performed; initial 15 minutes of one-on-one physician or other qualified health care professional contact with the patient
• CPT code 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)
• “Timed” codes that follow the “8 minute” rule
• CMS doesn’t specify difference in external or internal biofeedback
• You can’t bill 90913 without billing 90912, but can bill 90913 more than once in a session if needed         based on treatment time, i.e. additional 15 minutes
• Can we use a different code, i.e. ther act or neuromuscular re-ed if using biofeedback for certain diagnoses other than incontinence?  As with all treatment/procedures you should select the CPT code that most closely reflects the intent for treatment. Documentation should include how you used biofeedback during your treatment using other codes listed above.
• These are “sometimes” codes. What does that mean? This is a term used by CMS to permit physicians and Non-Physician Practitioners (NPPs), including nurse practitioners, physicians assistants, and certified nurse specialist to furnish these services outside a therapy plan of care when appropriate.

NEW COGNITIVE FUNCTION CODES – They replaced CPT code 97127 (CMS didn’t recognize) and HCPCS code G0515 – Development of cognitive skills to improve attention, memory, problem solving (includes compensatory training), direct (one-on-one) patient contact, each 15 minutes.

• CPT code 97129 – Therapeutic interventions that focus on cognitive function (e.g., attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (e.g., managing time or schedules, initiating, organizing and sequencing tasks), direct (one-on-one) patient contact; initial 15 minutes
• CPT code 97130 – Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (e.g., managing time or schedules, initiating, organizing and sequencing tasks), direct (one-on-one) patient contact; each additional 15 minutes (List separately in addition to code for primary procedure)
• These are not replacing CPT code 97530- therapeutic activity that the therapist uses to improve functional performance. Again, these codes are used for cognitive function therapy.

WILL ANY OF THE NEW CODES BE COVERED? WHAT DIAGNOSES ARE COVERED FOR BIOFEEDBACK?

• You’ll have to check with your 3^rd party payers to make sure they have included the new CPT codes in their system and are recognizing them for payment. This includes your state Medicaid policy.
• As far as diagnoses covered, again, you’ll need to look at see what ICD-10 codes are included as covered with these CPT treatment codes.

BOTTOM LINE

As with all treatment/procedures you should select the CPT code that most closely reflects the intent for treatment. You should also refer to payer policy to determine if they have specific guidance regarding the use of these (or any CPT) codes for a particular procedure/treatment.