May 30, 2001
Medi-987-01
TO: ALL MEDICARE PROVIDERS
SUBJECT: BIOFEEDBACK TRAINING FOR URINARY INCONTINENCE
PRIMARY INTERESTS: BUSINESS OFFICE MANAGERS, MEDICAL DIRECTORS
EFFECTIVE DATE: JULY 1, 2001
Attached is a copy of the Health Care Financing Administration's Coverage Issues Manual Transmittal number 138. This information supplements Medi 983-01 (5/25/01).
THIS BULLETIN SHOULD BE SHARED WITH ALL HEALTH CARE PRACTITIONERS AND MANAGERIAL MEMBERS OF THE PROVIDER STAFF. NO COST COPIES ARE ALSO AVAILABLE FROM OUR WEB SITE AT riverbendgba.com
Please refer any questions to our office toll free at 877-296-6189.
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Medicare |
Department of Health and Human Services (DHHS) |
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Coverage Issues Manual |
HEALTH CARE FINANCING ADMINISTRATION (HCFA) |
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Transmittal 138 |
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Date: MAY 15, 2001 |
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CHANGE REQUEST 1535 |
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HEADER SECTION NUMBERS |
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Table of Contents |
2pp. |
2pp. |
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35-27 - 35-33 |
6pp. |
6pp. |
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NEW/REVISED MATERIAL--EFFECTIVE DATE: July 1, 2001
IMPLEMENTATION DATE: July 1, 2001
Section 35-27.1, Biofeedback Therapy for the Treatment of Urinary Incontinence, is added to delineate the coverage policy for biofeedback for the treatment of urinary incontinence.
This section of the Coverage Issues Manual is a national coverage decision made under §1862(a)(1) of the Social Security Act. National coverage determinations (NCDs) are binding on all Medicare carriers, intermediaries, peer review organizations, and other contractors. Under 42 CFR §422.256(b) a NCD that expands coverage is also binding on a Medicare+Choice organization. In addition, an administrative law judge may not disregard, set aside, or otherwise review a national coverage decision issued under §1862(a)(1), (see 42 CFR §§ 405.732, 405.860).
NOTE: The period between Jaunary 1, 2001 and the date of issue should be used to review any local medical review policies for biofeedback for the treatment of urinary incontinence for any adjustments and provider education.
These instructions should be implemented within your current operating budget.
DISCLAIMER: The revision date and transmittal number only apply to the redlined material. All other material was previously published in the manual and is only being reprinted.
HCFA-Pub. 6
35-27.1 COVERAGE ISSUES - MEDICAL PROCEDURES 05-01
35-27.1 BIOFEEDBACK THERAPY FOR THE TREATMENT OF URINARY INCONTINENCE
Biofeedback therapy for the treatment of urinary incontinence (Effective for services performed on or after July 1, 2001.) This policy applies to biofeedback therapy rendered by a practitioner in an office or other facility setting.
Biofeedback is covered for the treatment of stress and/or urge incontinence in cognitively intact patients who have failed a documented trial of pelvic muscle exercise (PME) training. Biofeedback is not a treatment, per se, but a tool to help patients learn how to perform PME. Biofeedback-assisted PME incorporates the use of an electronic or mechanical device to relay visual and/or auditory evidence of pelvic floor muscle tone, in order to improve awareness of pelvic floor musculature and to assist patients in the performance of PME.
A failed trial of PME training is defined as no clinically significant improvement in urinary incontinence after completing 4 weeks of an ordered plan of pelvic muscle exercises to increase periurethral muscle strength.
Contractors may decide whether or not to cover biofeedback as an initial treatment modality.
Home use of biofeedback therapy is not covered.