2020 MEDICARE NATIONAL AVERAGE REIMBURSEMENT
Payment examples assume a Manometric biofeedback treatment session lasting 45 minutes

CPT® CODE WITH DESCRIPTION

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

+ 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)

Note: the symbol “+” represents a CPT “Add-on” code that must be billed with a primary service and never alone.

1. Physicians and Physical Therapists In-office (Medicare in-office claim):

• 90912 (1 unit): $82
• + 90913 (2 units): $66
• Total per each treatment session: $148*
  • Total for Completed Biofeedback: $888**

2. Facility/Hospitals (two separate claims are submitted):

• Hospital 90912 (1 unit): $36
• Hospital + 90913 (2 units): $16
  • APC Status Indicator “A” (Services Paid under Other Fee Schedule or Payment System)
• Physician 90912 (1 unit): $45
• Physician + 90913 (2 units): $51
• Total per each treatment session: $148*
  • Total for Completed Biofeedback:$888**

*Source: Pivotal Reimbursement Consulting

**6 bi-weekly therapy sessions are recommended to complete manometric biofeedback treatment

Note: E/M CPT code (office visit) can be submitted separately, if considered by the provider as medically necessary.