Neurology & Pain Management Coding Alert

Question: I have several patients who need portable biofeedback units to use at home. How can I bill the insurance carrier for the use of these units?

Mona Ristovv
Biofeedback Service of Louisiana
Lafayette, La.

Answer: Catherine A. Brink, CMM, CPC, president of Healthcare Resources Management, Inc., a practice management and reimbursement consulting firm in Spring Lake, N.J., that consults with several neurology practices, says that if the neurologist owns the biofeedback units or is paying for their rental, it then is possible to pass along a charge to the patient for the use of these units. If the biofeedback units are just loaned to the neurologist at no charge from a hospital or manufacturer, then the patient may not be charged.

Under this latter circumstance, however, a provision should be put in place in the loan agreement to cover the potential of patient damage to the unit so that the neurologist is not liable. A similar provision could be made with the patient if the neurologist owns the units, similar to equipment rental terms in many businesses. But, a if you break it, you have bought it provision could dissuade patients from using the machines at all and should be researched thoroughly with a medical attorney before implementation.

There is no CPT code for use of a biofeedback unit, Brink says. There are CPT codes for the neurologist to use when conducting biofeedback training with a patient. Those are 90901 (biofeedback training by any modality) and 90911 (biofeedback training, perineal muscles, anorectal or urethral sphincter, including EMG and/or manometry). After the training, the patient will be able to perform the biofeedback correctly in the home. The neurologist should contact his or her local Medicare provider as well as the five top third-party payers and inform them of the service that is being provided to determine if and how reimbursement can be obtained.

`Brink feels that some third-party payers may pay with the use of CPT code 99199, (unlisted special service, procedure or report) but Medicare carriers are unlikely to cover this service. If Medicare determines that use of a biofeedback unit is a non-covered service, then the neurologist can ask for payment of a rental fee or whatever the neurologist would determine the fee to be for use of the biofeedback unit. Under these circumstances, the patient should be advised that this is a non-covered service by Medicare and the neurologist would not need Medicare patients to sign a waiver of liability statement or ABN (advanced beneficiary notice) if Medicare states this is a non-covered service.