CPT Code 90913: Biofeedback training, each additional 15 minutes

Introduction

CPT Code 90913 is used in medical billing to report additional 15-minute increments of neuromuscular electrical stimulation (NMES) for pelvic floor dysfunction therapy. It is billed in conjunction with CPT Code 90912, which covers the initial 15-minute session. This procedure is primarily used to treat patients suffering from urinary and fecal incontinence, pelvic pain, and other neuromuscular disorders of the pelvic region.

In this blog, we will cover billing guidelines, reimbursement strategies, documentation requirements, common mistakes to avoid, and best practices to ensure successful claims processing and full reimbursement.

What is CPT Code 90913?

Definition and Purpose

CPT 90913 is a time-based add-on code used for neuromuscular electrical stimulation (NMES) therapy. It represents each additional 15-minute session after the initial CPT 90912-coded procedure. This therapy involves the use of electrical currents to stimulate pelvic floor muscles, improving control over bladder and bowel functions.

Importance of CPT Code 90913 in Medical Billing and Coding

• Ensures correct reimbursement for extended NMES therapy beyond the initial 15-minute session.
• Supports the documentation of comprehensive treatment plans for patients with pelvic dysfunction.
• Helps distinguish short vs. extended treatment durations, optimizing revenue for healthcare providers.
• Allows for accurate coding when treating complex cases requiring longer therapy sessions.

Common Medical Conditions Treated with CPT Code 90913

CPT Code 90913 is typically used for patients requiring ongoing neuromuscular stimulation for pelvic dysfunction. Conditions include:

• Urinary incontinence (ICD-10: N39.3, N39.4) – Loss of bladder control due to weak pelvic muscles.
• Fecal incontinence (ICD-10: R15.9) – Inability to control bowel movements.
• Pelvic pain syndromes (ICD-10: G89.29, R10.2) – Chronic pain associated with neuromuscular disorders.
• Postpartum pelvic dysfunction (ICD-10: O90.89) – Weak pelvic floor muscles after childbirth.
• Neurogenic bladder (ICD-10: N31.9) – Dysfunction due to neurological conditions like MS or stroke.
• Pelvic floor dysfunction (ICD-10: N81.4) – Disorders affecting bowel, bladder, and sexual function.

Who Can Bill CPT Code 90913?

Eligible Healthcare Providers

Only licensed healthcare professionals who perform neuromuscular stimulation therapy can bill CPT Code 90913. This includes:

• Physical Therapists (PTs) – Specializing in pelvic rehabilitation.
• Occupational Therapists (OTs) – Treating neuromuscular dysfunction.
• Physicians (Urologists, Gynecologists, Physiotherapists) – Managing pelvic floor disorders.
• Chiropractors – Provide NMES therapy for pelvic conditions.
• Nurse Practitioners (NPs) – Involved in pelvic dysfunction treatments.

Applicable Treatment Settings

CPT Code 90913 can be billed in various healthcare settings where supervised NMES therapy is provided, such as:

• Outpatient rehabilitation clinics – Specialized therapy centers for pelvic dysfunction.
• Hospitals – Inpatient or outpatient settings.
• Urology or gynecology clinics – Managing pelvic health disorders.
• Chiropractic or physiotherapy clinics – Providing NMES therapy.
• Home healthcare services – If covered by the insurer.

Related CPT Codes with 90913

Frequently Billed Together

Comparison with Similar CPT Codes

Step-by-Step Billing Method for CPT Code 90913

• Confirm Medical Necessity – Ensure the therapy is required and properly documented.
• Verify Insurance Coverage – Check payer policies on NMES therapy coverage.
• Perform the Therapy Session – Conduct the additional 15-minute NMES procedure.
• Document Treatment Details – Include therapy duration, patient response, and medical justification.
• Submit Claim – Use CPT 90912 for the first 15 minutes and CPT 90913 for additional increments.

Reimbursement Guidelines for CPT Code 90913

Insurance and Medicare/Medicaid Policies

• Medicare and private insurers require documentation of medical necessity.
• Medicaid coverage varies by state; prior authorization may be needed.
• Some payers limit the number of NMES sessions per patient per year.

How to Maximize Reimbursement for CPT Code 90913

Best Practices for Full Compensation

• Always bill CPT 90912 first before adding CPT 90913.
• Document therapy necessity thoroughly with detailed session notes.
• Verify insurance policies for NMES therapy limits.
• Use correct modifiers to prevent claim denials.

Commonly Approved Modifiers

• Modifier 59 – Indicates a separate, distinct NMES procedure.
• Modifier 25 – When NMES therapy is performed with an evaluation and management (E/M) service.

Common Billing Mistakes and How to Avoid Them

Frequent Coding Errors & Claim Denials

• Billing CPT 90913 without CPT 90912 – 90913 is an add-on code and cannot be billed alone.
• Insufficient documentation – Always include medical necessity and patient progress reports.
• Using incorrect diagnosis codes – Ensure ICD-10 codes support NMES therapy.

Conclusion

CPT Code 90913 is crucial for billing additional NMES therapy sessions for pelvic floor dysfunction. Proper documentation, coding accuracy, and compliance with insurance policies ensure successful claims and maximum reimbursement.

FAQs

Can CPT 90913 be billed without CPT 90912?

No, 90913 is an add-on code and must be billed with CPT 90912.

Does Medicare cover CPT 90913?

Yes, if deemed medically necessary and properly documented.

What is the reimbursement rate for CPT 90913?

It varies by payer but typically ranges from $35-$60 per session.

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