Payment

Published January 1, 2026

What You Need to Know 

Insurance coverage for pelvic health physical therapy varies widely. Most major payers—including Medicare, Medicaid, and commercial insurers—cover services when deemed medically necessary, especially for urinary incontinence. Reimbursement often depends on the use of accurate diagnosis codes, appropriate documentation, and demonstrating that conservative treatments have been attempted. 

• Pelvic floor exercises are typically covered for a range of conditions. 

• Biofeedback is often reimbursed for urinary and fecal incontinence after failed conservative care. 

• Electrical stimulation may require prior authorization or may be considered investigational by some insurers.

Payment coverage for physical therapy for pelvic health is highly variable. It is important to review not only the payer policies for physical therapy, but additional policies related to pelvic health. Most major insurers, including Blue Cross, Medicare, Medicaid, Cigna, Aetna, UnitedHealthcare, and Humana, typically cover pelvic floor physical therapy when it is deemed medically necessary. The majority of payer policies and cited literature is focused on urinary incontinence. Referenced treatment includes electrical stimulation, electromagnetic therapy, pelvic floor exercises, and biofeedback. 

The following are general statements reflecting most payer policies: 

• Pelvic floor exercises are considered medically necessary and covered for a variety of conditions. 

• Electrical stimulation may be covered for women who are unable to perform an effective pelvic floor muscle contraction, however many payer policies consider electrical stimulation and electromagnetic therapy not medically necessary or investigational. 

• Biofeedback may be considered medically necessary and covered in the presence of urinary incontinence. 

As in most cases, it is critical to know which ICD10 codes will support the delivery of physical therapy for pelvic health and to know documentation requirements. 

Florida Blue Medical Policy - Biofeedback 

The Blue Cross Blue Shield of Florida medical coverage guideline says:

Biofeedback specific to the perineal muscles, and/or anorectal or urethral sphincter meets the definition of medical necessity for treatment of: 

• Fecal incontinence when ALL the following are met: 

• There is some degree of rectal sensation. 

• The underlying cause is determined to be an ineffective anal sphincter squeeze function. 

• Ability to contract the sphincter voluntarily. 

• Conservative treatments (e.g., medication, diet changes) have failed. 

• Treatment does not exceed 6 biofeedback sessions. 

• Stress, urge, mixed, overflow or persistent post-prostatectomy urinary incontinence when conservative treatments (e.g., medications, timed voiding, pelvic floor muscle exercises) have failed, up to 12 feedback sessions (one per week) 

• ***Chronic constipation when conservative treatments (e.g., dietary changes, enemas,  laxatives, prescription drug therapy, suppositories) have failed, up to 6 biofeedback sessions. 

Biofeedback is considered experimental or investigational for treatment of all other conditions (BSBCF 2025). 

BCBS South Carolina 

Prior authorization is required for pelvic floor electrical stimulation with a non-implantable stimulator for the treatment of stress and/or urge urinary incontinence in cognitively intact patients who have failed a documented trial of pelvic muscle exercise (PME) training (CMMS n.d.-a). 

CMS Medicare Part B Biofeedback for incontinence 

“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 four weeks of an ordered plan of pelvic muscle exercises to increase periurethral muscle strength” (CMMS n.d.-b).  

“When providing biofeedback procedures for urinary incontinence, use CPT 90901 when EMG and/or manometry are not performed. CPT 90912 and 90913 describe biofeedback that is more involved than conventional biofeedback measures (code 90901) and includes evaluations of the EMG activity of the pelvic muscles, urinary sphincter, and/or anal sphincter by using sensors. This procedure can use manometry (measure of pressure of gases or liquids by use of a manometer) or EMG (electromyography - the recording of electrical activity initiated in the muscle tissue for testing purposes) to measure activity. The EMG activity is evaluated and provides objective information regarding the muscle activity and provides a basis for pelvic muscle rehabilitation utilizing biofeedback.

“Additional documentation is necessary to justify biofeedback services beyond 5-6 visits.  

“Supportive Documentation Requirements (required at least every 10 visits) for 90901 and 90912/90913 As noted in the NCD descriptions above, biofeedback is covered only when more conventional treatments such as heat, cold, massage, exercise (such as PME), and/or support have not been successful. Therefore, documentation must provide a clear history of the conventional treatments unsuccessfully tried before initiating biofeedback. Since biofeedback is only covered when there is a lack of response to other therapies, the lack of response to or contraindication to, other therapies must be noted in the patient's record. 

“Additionally for the treatment of incontinence, include: identification of the type and degree of incontinence, expectations from the treatment and the time frame in which improvement is anticipated. clear documentation of the formal instruction, monitoring, and follow-up of a prescribed course of PME, evidence of behavioral modification training including, but not limited to, bladder retraining and fluid intake modification, the use of a patient record-keeping system, such as a personal voiding diary, in evaluating and monitoring progress” (CMMS n.d.-a).

Aetna Biofeedback Policy 

Covered Pelvic Health Related ICD10 Codes 

• K58.0 - K58.9 Irritable bowel syndrome 
• K59.00 - K59.09 Constipation [chronic] 
• K59.4 Anal spasm [levator ani syndrome] 
• N39.0 - N39.9 Urinary incontinence 
• N39.41 - N39.46 Incontinence of urine 
• R15.0 - R15.9 Fecal incontinence 

Non-Covered Pelvic Health Related ICD10 Codes 

• M62.48 Contracture of muscle, other site [pelvic floor dysfunction] 
• N31.9 Neurogenic bladder dysfunction NOS 
• N32.81 Overactive bladder N32.89 Other specified disorders of bladder [non-neuropathic voiding disorders] 
• N41.1 Chronic prostatitis [abacterial] 
• N94.2 Vagismus 
• N94.818 - N94.819 Vulvodynia 
• O00.00 - O9A.53 Pregnancy, Childbirth and the Puerperium [labor pain] 
• R33.0 - R33.9 Retention of urine 
• R35.0 - R35.89 Polyuria [daytime syndrome] 

References