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Reimbursement Q & A: Billing for Electrodes

Posted on: June 28th, 2016 by Aika Barzhaxynova No Comments

By Kelly Huestis, PT, MPT

The Section on Women’s Health receives many payment reimbursement questions from physical therapists providing a range of services. Here is one of the most common, according to the SOWH ReimburseKelly Huestis, chair of the SOWH Reimbursement Committee, addresses a common question on electrode reimbursement codes. ment Committee:

Question:  Our physical therapists do internal vaginal biofeedback and/or electrical stimulation. The electrode probes we use are $40 each, and we want to ensure we are using the most appropriate CPT codes to charge for this intervention. Do you have any advice for us? “90911” seems like an appropriate code. Is anyone else using it?

Answer: The Reimbursement Committee regularly receives questions regarding proper billing for incontinence patients and how to maximize payment to cover the cost of equipment, probes, and electrodes. Recapturing the cost of the intra-vaginal probes can be a huge expense issue for many outpatient clinics.

Regarding this question, yes, some clinics are still using the “90911” CPT code (biofeedback services and procedures) for biofeedback. However, I would caution you since many payers do not reimburse for that code, and coverage determinations can vary by state. Talk to each individual payer about what they allow. Several stipulations and criteria must still be met for billing Medicare, and you also should look at your state’s local coverage determinations as related to biofeedback billing.

See the following link for Medicare guidelines and National Coverage Determinations (section 30.1.1 and section 230.8): https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/r10ncd.pdf.

Other clinics use EMG feedback as a tool to assist with neuromuscular re-education or therapeutic exercise and to document and bill as such. If a clinic believes these charges are not adequate to compensate for the cost of the probe, here are other options:

  1. Have the patient purchase their own electrodes.
  2. Consider the use of surface electrodes, when possible, rather than intra-vaginal probes. These are significantly less expensive and can be just as effective for many patients.
  3. Check out corporate deals. For instance, cmtmedical.com will let you set up an account where patients go to purchase electrodes at a discount.
  4. Buy the electrodes and sell them to patients but consider DME licensing and sales tax.

Stay tuned this year to the Section on Women’s Health’s Payment, Policy, and Advocacy webpage for regular updates on billing for pelvic floor muscle dysfunction. For more payment questions, email the Reimbursement Committee at [email protected].

AUTHOR: Kelly Huestis, PT, MPT, is chair of the Section on Women’s Health Reimbursement Committee. She can be reached at [email protected]

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