Local Coverage Article Billing and Coding

Billing and Coding: Urodynamic Services - Non-invasive


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Article Information

General Information

Article ID
Article Title
Billing and Coding: Urodynamic Services - Non-invasive
Article Type
Billing and Coding
Original Effective Date
Revision Effective Date
Revision Ending Date
Retirement Date
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CMS National Coverage Policy

Internet-Only Manuals (IOMs)

  • CMS IOM Publication 100-03, Medicare National Coverage Determinations (NCD) Manual,
    • Chapter 1, Section 230.2 Uroflowmetric Evaluations
  • CMS IOM Publication 100-02, Medicare Benefit Policy Manual,
    • Chapter 15, Section 60 Services and Supplies, Section 80 Requirements for Diagnostic X-Ray, Diagnostic Laboratory, and Other Diagnostic Tests
  • CMS Publication 100-08, Medicare Program Integrity Manual,
    • Chapter 13, Section 13.5.4 Reasonable and Necessary Provision in an LCD

Federal Register References:

  • 42 Code of Federal Regulations, 410.32 Diagnostic x-ray tests, diagnostic laboratory tests, and other diagnostic tests: Conditions
  • 42 Code of Federal Regulations, 410.33 Independent diagnostic testing facility
  • 42 Code of Federal Regulations, 410.74 Physician assistants’ services
  • 42 Code of Federal Regulations, 410.75 Nurse practitioners’ services
  • 42 Code of Federal Regulations, 410.76 Clinical nurse specialists’ services

Social Security Act (Title XVIII) Standard References:

  • Title XVIII of the Social Security Act, Section 1833(e) states that no payment shall be made to any provider of services or other person under this part unless there has been furnished such information as may be necessary in order to determine the amounts due such provider or other person under this part for the period with respect to which the amounts are being paid or for any prior period.
  • Title XVIII of the Social Security Act, Section 1862(a)(1)(A) excludes expenses incurred for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.

Article Guidance

Article Text

Urodynamic tests include: Cystometry, Electromyography, Urethral Pressure Profile, Uroflowmetry and Voiding Pressure Study; which are used to define the functional status of the lower urinary tract and to assist in the diagnosis of signs and symptoms of lower urinary tract problems or to guide further medical and/or surgical decision-making for urologic dysfunction.

The penile cuff is a non-invasive diagnostic test for male urinary disorders, also known as lower urinary tract symptoms (LUTS) such as urgency, frequency, nocturia and incomplete emptying. The test uses an external penile cuff (resembling a blood pressure cuff) instead of a catheter to measure bladder pressure while also calculating urine flow rate. This Billing and Coding Article provides billing and coding guidance for Urodynamic testing performed when using a penile pressure cuff for a urethral pressure study.

Coding Guidance

Notice: It is not appropriate to bill Medicare for services that are not covered (as described by the entire Billing and Coding Article) as if they are covered. When billing for non-covered services, use the appropriate modifier.

When there is no CPT/HCPCS code available to describe the service(s) performed, the appropriate CPT/HCPCS Not Otherwise Classified (NOC) code must be submitted.

Non-invasive urodynamic studies, i.e., those performed without catheterization are to be reported using the CPT code 55899 with non-invasive urodynamic studies (e.g. UroCuff®) noted in the narrative portion of the claim.

Documentation Requirements

  1. All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
  2. Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service[s]). The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
  3. The submitted medical record must support the use of the selected ICD-10-CM code(s). The submitted CPT/HCPCS code must describe the service performed.
  4. Documentation includes signs and symptoms of voiding dysfunction, a relevant medical history, physical exam, urinalysis with urine microscopy and effectiveness of treatment when there is a diagnosis of urinary tract infection.
  5. Printouts from the electronic equipment are considered part of the documentation and should be included in the patient’s official medical record in addition to the professional interpretation and supervision report.

Coding Information


Group 1

(1 Code)
Group 1 Paragraph

The following CPT code associated with the services outlined in this Billing and Coding Article will not have diagnosis code limitations applied at this time.

CPT code 55899 is to be reported when using a penile pressure cuff for a urethral pressure study.

Note: Providers are reminded to refer to the long descriptors of the CPT codes in their CPT book.

Group 1 Codes
55899 Unlisted px male genital sys

CPT/HCPCS Modifiers


ICD-10-CM Codes that Support Medical Necessity

Group 1

(1 Code)
Group 1 Paragraph


Group 1 Codes
XX000 Not Applicable

ICD-10-CM Codes that DO NOT Support Medical Necessity


ICD-10-PCS Codes


Additional ICD-10 Information


Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

999x Not Applicable

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

99999 Not Applicable

Other Coding Information


Revision History Information

Revision History DateRevision History NumberRevision History Explanation
01/01/2023 R1

Article revised and published on 01/26/2023 effective for dates of service on and after 01/01/2023 to reflect the Annual HCPCS/CPT Code Updates. For the following CPT code either the short description and/or the long description was changed. Depending on which description is used in this article, there may not be any change in how the code displays: 55899 in Group 1 Codes.

Associated Documents

Related Local Coverage Documents
Related National Coverage Documents
Statutory Requirements URLs
Rules and Regulations URLs
CMS Manual Explanations URLs
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Public Versions
Updated On Effective Dates Status
01/20/2023 01/01/2023 - N/A Currently in Effect You are here
11/06/2020 11/12/2020 - 12/31/2022 Superseded View