CPT 90913: Biofeedback Training for Incontinence
CPT code 90913 covers time-based, face-to-face biofeedback training delivered by a physician or other qualified healthcare professional to help patients gain voluntary control over involuntary functions such as pelvic floor activity, blood pressure, or heart rate. The code is used for management of conditions like fecal or urinary incontinence and includes associated EMG and manometry when performed. It is reported for each additional 15 minutes of direct patient training beyond an initial service.
This code matters nationally as biofeedback is a noninvasive, rehabilitative technique increasingly incorporated into conservative management pathways for pelvic-floor and autonomic dysfunction. Payers commonly referenced in analyses include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Coverage, coding guidance, and allowed services can affect access to biofeedback as a treatment option across outpatient and clinic settings.
Readers will learn the clinical intent of the code, typical service settings, the payer landscape covered in this review, and what to expect in terms of how the code is used in practice. The publication covers benchmarks, common billing considerations, and recent policy or coverage trends relevant to biofeedback training. Data not available in the input will be noted where applicable.
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Billing Code Overview
CPT code 90913 describes face-to-face biofeedback training provided by a physician or other qualified healthcare professional to help a patient gain voluntary control over involuntary bodily functions. The service focuses on modifying brain activity, blood pressure, heart rate, and other autonomic or pelvic-floor functions for conditions such as fecal or urinary incontinence. Electromyography (EMG) and manometry, when performed, are included as part of this service.
Service Type: Therapeutic biofeedback training, time-based
Typical Site of Service: Outpatient clinic or office setting, including specialist pelvic floor or continence clinics, and can occur in hospital outpatient departments when provided by qualified professionals.
Clinical & Coding Specifications
Clinical Context
A 58-year-old female with long-standing urinary urgency and mixed urinary incontinence is referred to a urogynecology clinic for biofeedback-assisted pelvic floor muscle training. The physician evaluates the patient, documents baseline symptoms, and initiates face–to–face biofeedback training using surface electromyography and manometry sensors to teach voluntary control of pelvic floor and sphincter muscles. The initial session includes instruction, sensor placement, demonstration of technique, and guided practice during a 30-minute visit; EMG and manometry recordings are obtained and interpreted as part of the session. Follow-up sessions occur weekly for additional 15-minute blocks of face–to–face biofeedback training as the patient gains control and learns home exercises. Typical documentation includes patient consent, indication (urinary or fecal incontinence), time spent in direct patient contact, modalities used (EMG/manometry), objective measurements, patient response, and a plan for subsequent sessions. Typical site of service is an outpatient specialty clinic (urogynecology, colorectal, or pelvic floor rehabilitation) or ambulatory surgery center when performed as part of a multidisciplinary pelvic floor program.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Normal, usual, or customary service | When reporting the primary service without any unusual circumstances. |
22 | Increased procedural services | When substantially greater work is required beyond typical biofeedback training (document rationale). |
23 | Unusual anesthesia | Not typical for this procedure but used if unexpected anesthesia is required; rarely applicable. |
52 | Reduced services | For a session abbreviated due to clinical reasons; document reduced scope and time. |
59 | Distinct procedural service | When another separately identifiable service is performed on the same day that is not integral to biofeedback training. |
62 | Two surgeons | If two qualified providers of different specialties jointly provide biofeedback training (rare). |
78 | Unplanned return to the operating/procedure room | Use if an unplanned additional procedure related to treatment occurs after an initial procedure (rare for outpatient biofeedback). |
80 | Assistant surgeon | If an assistant surgeon participates in a procedure component related to the episode of care. |
96 | Habilitative services | To indicate services that help the patient acquire or maintain skills, when payer requires habilitation designation. |
97 | Rehabilitative services | To indicate rehabilitative services when required by payer reporting rules. |
59 | Distinct procedural service | (Duplicate entry avoided in practice; included above as commonly relevant.) |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| Data not available in the input. | Urogynecology / Female Pelvic Medicine | Physicians who commonly manage pelvic floor dysfunction and deliver biofeedback training. |
| Data not available in the input. | Physical Medicine & Rehabilitation (PM&R) / Pelvic Floor Therapist | PM&R physicians and therapists who provide rehabilitative biofeedback services. |
| Data not available in the input. | Gastroenterology / Colorectal Surgery | Specialists who manage fecal incontinence and use anorectal biofeedback and manometry. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
N39.3 | Stress incontinence (female) | Common indication for pelvic floor biofeedback to improve sphincter control and reduce leakage. |
N39.41 | Urge incontinence | Frequent reason for biofeedback and pelvic floor retraining to manage urgency and reduce episodes. |
N39.46 | Mixed urinary incontinence | Patients with combined stress and urge symptoms benefit from individualized biofeedback training. |
R32 | Unspecified urinary incontinence | Used when the type of incontinence is not yet classified during initial assessment. |
K59.2 | Neurogenic bowel, not elsewhere classified | Fecal incontinence related to neurologic bowel dysfunction where anorectal biofeedback may be indicated. |
K62.8 | Other specified diseases of anus and rectum (including fecal incontinence codes like R15 variants) | Anorectal dysfunction and fecal leakage are managed with biofeedback and sphincter retraining. |
R15.0 | Fecal incontinence, soiling | Direct indication for anorectal biofeedback to improve continence and sphincter control. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
90911 | Biofeedback training, perineal or pelvic floor, initial 30 minutes; without EMG/manometry separately reported | Alternative code for initial timed biofeedback sessions when specific inclusions differ; selects based on payer guidance. |
51784 | Measurement of urinary flow rate and voided volume, noninvasive | Performed before or during evaluation to quantify voiding dysfunction alongside biofeedback. |
51798 | Pelvic floor manometry | Diagnostic manometry may be used to assess sphincter pressures and is often integrated into training; some payers bundle manometry with 90913. |
95860 | Needle electromyography; one extremity, ganglion or anal sphincter (anal EMG) | Anal sphincter EMG may be performed in evaluation of fecal incontinence and can be included when combined with biofeedback sessions. |
97110 | Therapeutic exercises, each 15 minutes | Complementary pelvic floor therapeutic exercises and strengthening provided by physical therapists in conjunction with biofeedback training. |