Medicine
Chapter 7
Section 4.1
Biofeedback
Issue Date: January 23, 1984
Copyright: CPT only © 2006 American Medical
Association (or such other date of publication of CPT).
All Rights Reserved.
Revision:
1.0 CPT PROCEDURE CODES
90901, 90911
2.0 DESCRIPTION
Biofeedback therapy is a technique
by which a person is taught to exercise control over a physiologic process
occurring within the body. By using modern biomedical instruments
the patient learns how a specific physiologic system within his
body operates and how to modify the performance of this particular
system.
3.0 POLICY
3.1 Benefits
are payable for services and supplies in connection with electrothermal, electromyograph
and electrodermal biofeedback therapy when there is documentation
that the patient has undergone an appropriate medical evaluation,
that their present condition is not responding to or no longer responds
to other forms of conventional treatment and only provided in treatment
of the following conditions:
3.1.1 Adjunctive
treatment for Raynaud’s Syndrome.
3.1.2 Adjunctive
treatment for muscle re-education of specific muscle groups or for
treating pathological muscle abnormalities of spasticity, or incapacitating
muscle spasm or weakness.
3.1.3 Payable
benefits include initial intake evaluation. Treatment following
the initial intake evaluation is limited to a maximum of 20 inpatient
and outpatient biofeedback treatments per calendar year.
4.0 EXCLUSIONS
4.1 Treatment
of ordinary muscle tension states or for psychosomatic conditions.
4.2 Rental or purchase of biofeedback
equipment.
4.3 Hypertension.
4.4 Treatment of psychosomatic
(i.e., psychophysiological or psychological factors affecting medical
condition) conditions and for Current Procedural Terminology (CPT)
procedure codes 90875 and 90876.
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