TL;DR: Cigna Healthcare modified CPG294 (cpg294_biofeedback), its biofeedback coverage policy, effective November 15, 2025. Here's what billing teams need to do.
Cigna Healthcare updated its biofeedback coverage policy under policy code CPG294. The modification covers CPT codes 90901, 90912, and 90913 across a range of neurological, gastrointestinal, and urological diagnoses. If your practice bills biofeedback for conditions like urinary incontinence, fecal incontinence, migraine, or constipation, this policy governs your reimbursement and medical necessity criteria for those claims.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | Cigna Healthcare |
| Policy | Biofeedback (CPG294) |
| Policy Code | cpg294_biofeedback |
| Change Type | Modified |
| Effective Date | November 15, 2025 |
| Impact Level | Medium |
| Specialties Affected | Urology, gastroenterology, neurology, physical medicine & rehabilitation, pain management, pelvic floor therapy |
| Key Action | Audit active biofeedback claims against the updated ICD-10 coverage list and confirm medical necessity documentation before November 15, 2025 |
Cigna Biofeedback Coverage Criteria and Medical Necessity Requirements 2025
The Cigna biofeedback coverage policy under CPG294 designates CPT 90901, 90912, and 90913 as medically necessary when specific clinical criteria are met. The policy covers three broad categories of biofeedback: general biofeedback training (90901), perineal muscle and sphincter biofeedback with EMG and/or manometry (90912 and 90913), and neurofeedback or EEG biofeedback.
This is where the policy gets granular — and where claim denial risk lives. Medical necessity is tied directly to diagnosis. Cigna will not cover biofeedback simply because a provider ordered it. The ICD-10 code on the claim must match an approved indication in the policy.
The 41 covered ICD-10 codes in this policy fall into three clinical buckets: migraine and tension-type headache, gastrointestinal dysfunction, and urinary/fecal incontinence. If your diagnosis code falls outside those buckets, Cigna considers the service not medically necessary under CPG294.
Prior authorization requirements for biofeedback under this coverage policy vary by plan. Check the member's specific benefit plan before scheduling. Don't assume prior auth isn't required just because a prior claim went through — plan-level requirements can differ from the CPG294 policy itself.
Cigna Biofeedback Exclusions and Non-Covered Indications
The CPG294 policy explicitly excludes EEG biofeedback and neurofeedback from medical necessity coverage. Cigna considers these experimental and investigational. This applies regardless of diagnosis.
The real issue here is that many practices bill neurofeedback under CPT 90901 — which is a general biofeedback code. If Cigna determines that the service rendered was neurofeedback or EEG-based biofeedback, the claim will be denied even if 90901 is the billed code. Documentation of the modality matters. Be specific in your records about which biofeedback technology was used.
In-home biofeedback devices are also addressed in CPG294 and carry their own coverage limitations. If your practice or a related DME supplier bills for take-home biofeedback equipment, review the device-specific criteria separately. Billing for a device under a diagnosis that qualifies biofeedback as medically necessary does not automatically mean the device itself is covered.
Coverage Indications at a Glance
| Indication | Status | Relevant CPT Codes | Key ICD-10 Codes |
|---|---|---|---|
| Migraine (with and without aura, chronic, hemiplegic) | Covered when criteria met | 90901 | G43.001–G43.919, G43.E01–G43.E19 |
| Tension-type headache | Covered when criteria met | 90901 | G44.201–G44.209 |
| Urinary incontinence (stress, urge, mixed, overflow, unspecified) | Covered when criteria met | 90901, 90912, 90913 | N39.3, N39.41–N39.498, R32 |
| Fecal incontinence | Covered when criteria met | 90901, 90912, 90913 | R15.0–R15.9 |
| Constipation (unspecified, slow transit, outlet dysfunction, other) | Covered when criteria met | 90901, 90912, 90913 | K59.00–K59.09 |
| Anal spasm | Covered when criteria met | 90901, 90912, 90913 | K59.4 |
| Neoplasm-related pain | Covered when criteria met | 90901 | G89.3 |
| Cerebral infarction | Covered when criteria met | 90901 | I63.00–I63.9 |
| Genitourinary symptoms (unspecified) | Covered when criteria met | 90912, 90913 | R39.9 |
| EEG biofeedback / Neurofeedback | Not Covered — Experimental | 90901 | N/A |
| In-home biofeedback devices | Limited — separate device criteria apply | N/A | Plan-specific |
Cigna Biofeedback Billing Guidelines and Action Items 2025
These are the steps your billing team should take before the November 15, 2025 effective date.
| # | Action Item |
|---|---|
| 1 | Audit your active biofeedback orders against the CPG294 ICD-10 list. Pull every open biofeedback order or authorization in your system. Cross-check each diagnosis code against the 41 covered ICD-10 codes in this policy. Any order with a diagnosis outside that list is a claim denial waiting to happen. |
| 2 | Update your charge capture for CPT 90912 and 90913 before November 15, 2025. These codes are specific to perineal muscle and sphincter training with EMG and/or manometry. Make sure your EHR or charge capture system isn't defaulting all biofeedback to 90901. Using the wrong code for perineal biofeedback will trigger a mismatch and potentially a denial. |
| 3 | Document biofeedback modality in every session note. Cigna's CPG294 coverage policy distinguishes general biofeedback, perineal biofeedback, and neurofeedback. Your clinical documentation must specify which modality was used. "Biofeedback training" as a generic note is not enough — it exposes you to retroactive denial if Cigna audits and determines neurofeedback was provided. |
| 4 | Verify prior authorization requirements at the plan level for each patient. CPG294 sets coverage criteria, but prior auth requirements are plan-specific. Don't treat this policy as a blanket authorization. Confirm PA status for each Cigna member before the first biofeedback session. |
| 5 | Flag neurofeedback and EEG biofeedback claims immediately. If your practice bills any service that could be coded as neurofeedback, stop and review before November 15, 2025. Cigna considers these experimental under CPG294. Billing 90901 for neurofeedback won't protect you — the modality is what triggers the exclusion, not the code. |
| 6 | Review in-home biofeedback device billing separately. If you're involved in dispensing or prescribing biofeedback devices for home use, CPG294 has separate criteria for that. Don't assume a covered clinical diagnosis extends to device reimbursement. Review the device-specific section of CPG294 directly or loop in your compliance officer before billing for home-use equipment. |
| 7 | Check for cerebral infarction and neoplasm pain diagnoses in your biofeedback population. These are less obvious covered diagnoses. G89.3 (neoplasm-related pain) and I63.00–I63.9 (cerebral infarction) are in the covered ICD-10 list. If you have patients in these categories who could benefit from biofeedback, this policy supports billing 90901 for them when clinical criteria are met. |
| Previous Version | Current Version |
|---|---|
| Coverage is considered experimental and investigational for all indications | Coverage is considered medically necessary when specific criteria are met |
| Prior authorization is not required | Prior authorization is required for initial treatment |
| Documentation must include clinical history | Documentation must include clinical history |
| Re-review every 24 months | Re-review every 12 months with updated clinical documentation |
CPT, HCPCS, and ICD-10 Codes for Biofeedback Under CPG294
Covered CPT Codes (When Medical Necessity Criteria Are Met)
| Code | Type | Description |
|---|---|---|
| 90901 | CPT | Biofeedback training by any modality |
| 90912 | CPT | Biofeedback training, perineal muscles, anorectal or urethral sphincter, including EMG and/or manometry; initial 15 minutes of one-on-one physician or other qualified health care professional contact with the patient |
| 90913 | CPT | Biofeedback training, perineal muscles, anorectal or urethral sphincter, including EMG and/or manometry; each additional 15 minutes of one-on-one physician or other qualified health care professional contact with the patient |
Key ICD-10-CM Diagnosis Codes
| Code | Description |
|---|---|
| G43.001–G43.019 | Migraine without aura |
| G43.101–G43.119 | Migraine with aura |
| G43.401–G43.419 | Hemiplegic migraine |
| G43.501–G43.519 | Persistent migraine aura without cerebral infarction |
| G43.601–G43.619 | Persistent migraine aura with cerebral infarction |
| G43.701–G43.719 | Chronic migraine without aura |
| G43.801–G43.839 | Other migraine |
| G43.901–G43.919 | Migraine, unspecified |
| G43.E01–G43.E19 | Chronic migraine with aura |
| G44.201–G44.209 | Tension-type headache, unspecified |
| G89.3 | Neoplasm related pain (acute)(chronic) |
| I63.00–I63.9 | Cerebral infarction |
| K59.00 | Constipation, unspecified |
| K59.01 | Slow transit constipation |
| K59.02 | Outlet dysfunction constipation |
| K59.09 | Other constipation |
| K59.4 | Anal spasm |
| N39.3 | Stress incontinence (female)(male) |
| N39.41 | Urge incontinence |
| N39.42 | Incontinence without sensory awareness |
| N39.43 | Post-void dribbling |
| N39.44 | Nocturnal enuresis |
| N39.45 | Continuous leakage |
| N39.46 | Mixed incontinence |
| N39.490 | Overflow incontinence |
| N39.498 | Other specified urinary incontinence |
| R15.0–R15.9 | Fecal incontinence |
| R32 | Unspecified urinary incontinence |
| R39.9 | Unspecified symptoms and signs involving the genitourinary system |
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