Transcript No Slide Title

Coding and Billing in a
Biofeedback Practice
Ronald L. Rosenthal, Ph.D.
…authorization is not a
guarantee of payment
Contextual Background
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Federal Policy
State Statutes
Insurance Regulations/LMRP
Business Practices
Clinical & Theoretical Orientation
Practice Models
(or how to get the money)
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Fee for Service
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Third Party Reimbursement
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Mixed Collection Methods
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Section 403(c)
Provider Panels
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Can increase the number of patients
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Restricts your ability to set fees
Billing Prerequisites
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Diagnostic Code
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Procedure Code
Diagnostic Coding
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DSM IV for psychological
disorders
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ICD-10 for physical
disorders
Procedure Codes
 Current Procedual
Terminology (CPT code book)
 Primarily oriented to
physicians and treatment of
physical ailments
Biofeedback Codes
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90901 Biofeedback training
by any modality
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90911 Biofeedback training,
perineal muscles, anorectal or
urethral sphincter, including
EMG and/or manometry
Biofeedback and Psychotherapy
Combination Codes
 90876 Individual psychophysiological
therapy incorporating biofeedback training
by any modality (face to face with the
patient), with psychotherapy (eg, insight
oriented, behavior modifying or supportive
psychotherapy) 45-50 minutes
Retired Biofeedback Codes
 Prior to 1997 (the Golden Age) there
were multiple codes specific for modalities
of biofeedback – 90900, 90902, 90904,
90906, 90908, 90910 and 90915.
Alternative Codes For Biofeedback
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97112 Neuromuscular
reeducation of movement, balance,
kinesthetic sense, posture, and/or
proprioception for sitting and/or
standing activities.
Alternative Codes For Biofeedback
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97532 Development of cognitive
skills to improve attention, memory,
problem solving, (includes
compensatory training).
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Formerly 97770
Health and Behavior Assessment
And Intervention Codes
These codes describe services to patients
who present with established illnesses or
symptoms, who are not diagnosed with
mental illness, and may benefit from
evaluations that focus on the
biopsychosocial factors related to the
patient’s physical health status.
Rationale: Specific Examples
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Patient Adherence to Medical Treatment
Symptom Management & Expression
Health-promoting Behaviors
Health-related Risk-taking Behaviors
Overall Adjustment to Medical Illness
Overview of Codes
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New Subsection
Six New Codes
Assessment
Intervention
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Established Medical Illness or Diagnosis
Focus on Biopsychosocial Factors
Relative Values for Health &
Behavior Codes
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96150
96151
96152
96153
96154
96155
Assessment RVU = .50
Reassessment RVU = .48
Intervention RVU = . 46
Group RVU = .10
Family (with pt) RVU = .45
Family (w/o pt) RVU = .44
Reimbursement Rates and Relative
Value Units (RVUs)
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Three components
Physician Work
Practice Expense
Liability Insurance
Relative Value Units
and Reimbursment (2)
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The RVU is multiplied by a
conversion factor to determine
payment
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Biofeedback codes have
modest RVUs
Neurofeedback Evaluation Codes
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95816 Digital EEG recording
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95957 Digital EEG analysis
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99090 Reference EEG
database access
Modes of Claim Submission
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Hard Copy--Mailed
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Electronic Transmission
Modes of Claim Submission
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Hard Copy--Mailed
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Electronic Transmission
Electronic Submission of
Bills and HIPAA
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HIPAA compliance mandated
when an office engages in electronic
transmission of information.
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Small offices are exempted
from HIPAA compliance if they do
not use electronic transmission of
information.
Problems with Biofeedback Codes
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Not universally covered.
May require prior authorization.
Limitations on number of sessions.
Limitations on types of patients/disorders
eligible for reimbursement.
Poor reimbursement rates.
Time consuming to get authorization.
Medicare and Biofeedback
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Requires the use of a modifier (GP for
physical therapy) for payment.
There is a cap on outpatient
rehabilitation services (less than
$2000/year).
Medicare and Biofeedback
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Rehabilitation professionals are trying to
have the cap eliminated (The Medicare
Access to Rehabilitation Services Act of
2007).
Medicare and Biofeedback
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Medicare standards often adopted by
other insurance companies.
Coverage only for muscular retraining.
Excludes 90876.
Limited diagnostic codes eligible.
Payment is less than $45 regardless of the
length of session for 90901.