LCD Reference Article Billing and Coding Article

Billing and Coding: Urodynamics

A57455

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Draft Article
Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.

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General Information

Source Article ID
N/A
Article ID
A57455
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Urodynamics
Article Type
Billing and Coding
Original Effective Date
10/24/2019
Revision Effective Date
10/01/2023
Revision Ending Date
N/A
Retirement Date
N/A
AMA CPT / ADA CDT / AHA NUBC Copyright Statement

CPT codes, descriptions and other data only are copyright 2023 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

Current Dental Terminology © 2023 American Dental Association. All rights reserved.

Copyright © 2023, the American Hospital Association, Chicago, Illinois. Reproduced with permission. No portion of the American Hospital Association (AHA) copyrighted materials contained within this publication may be copied without the express written consent of the AHA. AHA copyrighted materials including the UB‐04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work without the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at 312‐893‐6816.

Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions; and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates.

CMS National Coverage Policy

Language quoted from Centers for Medicare and Medicaid Services (CMS), National Coverage Determinations (NCDs) and coverage provisions in interpretive manuals is italicized throughout the policy. NCDs and coverage provisions in interpretive manuals are not subject to the Local Coverage Determination (LCD) Review Process (42 CFR 405.860[b] and 42 CFR 426 [Subpart D]). In addition, an administrative law judge may not review an NCD. See §1869(f)(1)(A)(i) of the Social Security Act.

Unless otherwise specified, italicized text represents quotation from one or more of the following CMS sources:

Title XVIII of the Social Security Act (SSA):

Section 1833(e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim.

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.

CMS Publications:

CMS Publication 100-03, Medicare National Coverage Determinations (NCD) Manual, Chapter 1:

    230.2 Uroflowmetric Evaluations

Article Guidance

Article Text

This article contains coding and other guidelines that complement the Local Coverage Determination (LCD) for Urodynamics.

Coding Information:

Procedure codes may be subject to National Correct Coding Initiative (NCCI) edits or OPPS packaging edits. Refer to NCCI and OPPS requirements prior to billing Medicare.

For services requiring a referring/ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim.

A claim submitted without a valid ICD-10-CM diagnosis code will be returned to the provider as an incomplete claim under Section 1833(e) of the Social Security Act.

The diagnosis code(s) must best describe the patient's condition for which the service was performed. For diagnostic tests, report the result of the test if known; otherwise the symptoms prompting the performance of the test should be reported.

If a penile pressure cuff is used when providing a voiding pressure study, CPT Code 55899 should be reported with non-invasive urodynamic studies noted in the narrative portion of the claim.

Documentation Requirements:

Each claim must be submitted with ICD-10-CM codes that reflect the condition of the patient, and indicate the reason(s) for which the service was performed. Claims submitted without ICD-10-CM codes will be returned.

The patient's medical record must contain documentation that fully supports the medical necessity for services included within the related LCD. (See "Indications and Limitations of Coverage.") This documentation includes, but is not limited to, relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.

Documentation must be available to Medicare upon request.

Response To Comments

Number Comment Response
1
N/A

Coding Information

Bill Type Codes

Code Description
N/A

Revenue Codes

Code Description
N/A

CPT/HCPCS Codes

Group 1

(10 Codes)
Group 1 Paragraph

If a penile pressure cuff is used when providing a voiding pressure study, CPT Code 55899 should be reported with non-invasive urodynamic studies noted in the narrative portion of the claim.

CPT Code 55899 should only be used if a penile pressure cuff is used when providing a voiding pressure study.

Group 1 Codes
Code Description
51725 SIMPLE CYSTOMETROGRAM (CMG) (EG, SPINAL MANOMETER)
51726 COMPLEX CYSTOMETROGRAM (IE, CALIBRATED ELECTRONIC EQUIPMENT);
51727 COMPLEX CYSTOMETROGRAM (IE, CALIBRATED ELECTRONIC EQUIPMENT); WITH URETHRAL PRESSURE PROFILE STUDIES (IE, URETHRAL CLOSURE PRESSURE PROFILE), ANY TECHNIQUE
51728 COMPLEX CYSTOMETROGRAM (IE, CALIBRATED ELECTRONIC EQUIPMENT); WITH VOIDING PRESSURE STUDIES (IE, BLADDER VOIDING PRESSURE), ANY TECHNIQUE
51729 COMPLEX CYSTOMETROGRAM (IE, CALIBRATED ELECTRONIC EQUIPMENT); WITH VOIDING PRESSURE STUDIES (IE, BLADDER VOIDING PRESSURE) AND URETHRAL PRESSURE PROFILE STUDIES (IE, URETHRAL CLOSURE PRESSURE PROFILE), ANY TECHNIQUE
51736 SIMPLE UROFLOWMETRY (UFR) (EG, STOP-WATCH FLOW RATE, MECHANICAL UROFLOWMETER)
51741 COMPLEX UROFLOWMETRY (EG, CALIBRATED ELECTRONIC EQUIPMENT)
51792 STIMULUS EVOKED RESPONSE (EG, MEASUREMENT OF BULBOCAVERNOSUS REFLEX LATENCY TIME)
51797 VOIDING PRESSURE STUDIES, INTRA-ABDOMINAL (IE, RECTAL, GASTRIC, INTRAPERITONEAL) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
55899 UNLISTED PROCEDURE, MALE GENITAL SYSTEM
N/A

CPT/HCPCS Modifiers

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

(513 Codes)
Group 1 Paragraph

The correct use of an ICD-10-CM code listed below does not assure coverage of a service. The service must be reasonable and necessary in the specific case and must meet the criteria specified in the related LCD.

Group 1 Codes
Code Description
A18.13 Tuberculosis of other urinary organs
A52.10 Symptomatic neurosyphilis, unspecified
A52.11 Tabes dorsalis
A52.12 Other cerebrospinal syphilis
A52.13 Late syphilitic meningitis
A52.14 Late syphilitic encephalitis
A52.15 Late syphilitic neuropathy
A52.16 Charcot's arthropathy (tabetic)
A52.17 General paresis
A52.19 Other symptomatic neurosyphilis
A52.3 Neurosyphilis, unspecified
A80.9 Acute poliomyelitis, unspecified
C61 Malignant neoplasm of prostate
C70.1 Malignant neoplasm of spinal meninges
C72.0 Malignant neoplasm of spinal cord
C72.1 Malignant neoplasm of cauda equina
C79.82 Secondary malignant neoplasm of genital organs
D29.1 Benign neoplasm of prostate
D33.4 Benign neoplasm of spinal cord
D40.0 Neoplasm of uncertain behavior of prostate
D49.4 Neoplasm of unspecified behavior of bladder
D49.511 Neoplasm of unspecified behavior of right kidney
D49.512 Neoplasm of unspecified behavior of left kidney
D49.519 Neoplasm of unspecified behavior of unspecified kidney
D49.59 Neoplasm of unspecified behavior of other genitourinary organ
E10.21 Type 1 diabetes mellitus with diabetic nephropathy
E10.22 Type 1 diabetes mellitus with diabetic chronic kidney disease
E10.29 Type 1 diabetes mellitus with other diabetic kidney complication
E10.49 Type 1 diabetes mellitus with other diabetic neurological complication
E11.21 Type 2 diabetes mellitus with diabetic nephropathy
E11.22 Type 2 diabetes mellitus with diabetic chronic kidney disease
E11.29 Type 2 diabetes mellitus with other diabetic kidney complication
E11.49 Type 2 diabetes mellitus with other diabetic neurological complication
E13.21 Other specified diabetes mellitus with diabetic nephropathy
E13.22 Other specified diabetes mellitus with diabetic chronic kidney disease
E13.29 Other specified diabetes mellitus with other diabetic kidney complication
E13.49 Other specified diabetes mellitus with other diabetic neurological complication
E13.610 Other specified diabetes mellitus with diabetic neuropathic arthropathy
F45.8 Other somatoform disorders
F98.0 Enuresis not due to a substance or known physiological condition
G04.1 Tropical spastic paraplegia
G04.90 Encephalitis and encephalomyelitis, unspecified
G04.91 Myelitis, unspecified
G12.21 Amyotrophic lateral sclerosis
G20.A1 Parkinson's disease without dyskinesia, without mention of fluctuations
G20.A2 Parkinson's disease without dyskinesia, with fluctuations
G20.B1 Parkinson's disease with dyskinesia, without mention of fluctuations
G20.B2 Parkinson's disease with dyskinesia, with fluctuations
G20.C Parkinsonism, unspecified
G21.4 Vascular parkinsonism
G24.1 Genetic torsion dystonia
G35 Multiple sclerosis
G37.4 Subacute necrotizing myelitis of central nervous system
G60.9 Hereditary and idiopathic neuropathy, unspecified
G82.20 Paraplegia, unspecified
G82.21 Paraplegia, complete
G82.22 Paraplegia, incomplete
G82.50 Quadriplegia, unspecified
G82.51 Quadriplegia, C1-C4 complete
G82.52 Quadriplegia, C1-C4 incomplete
G82.53 Quadriplegia, C5-C7 complete
G82.54 Quadriplegia, C5-C7 incomplete
G83.4 Cauda equina syndrome
M46.41 Discitis, unspecified, occipito-atlanto-axial region
M46.42 Discitis, unspecified, cervical region
M46.43 Discitis, unspecified, cervicothoracic region
M46.44 Discitis, unspecified, thoracic region
M46.45 Discitis, unspecified, thoracolumbar region
M46.46 Discitis, unspecified, lumbar region
M46.47 Discitis, unspecified, lumbosacral region
M50.80 Other cervical disc disorders, unspecified cervical region
M50.81 Other cervical disc disorders, high cervical region
M50.83 Other cervical disc disorders, cervicothoracic region
M50.90 Cervical disc disorder, unspecified, unspecified cervical region
M50.91 Cervical disc disorder, unspecified, high cervical region
M50.93 Cervical disc disorder, unspecified, cervicothoracic region
M51.84 Other intervertebral disc disorders, thoracic region
M51.85 Other intervertebral disc disorders, thoracolumbar region
M51.86 Other intervertebral disc disorders, lumbar region
M51.87 Other intervertebral disc disorders, lumbosacral region
N13.0 Hydronephrosis with ureteropelvic junction obstruction
N13.1 Hydronephrosis with ureteral stricture, not elsewhere classified
N13.2 Hydronephrosis with renal and ureteral calculous obstruction
N13.39 Other hydronephrosis
N13.70 Vesicoureteral-reflux, unspecified
N13.71 Vesicoureteral-reflux without reflux nephropathy
N13.721 Vesicoureteral-reflux with reflux nephropathy without hydroureter, unilateral
N13.731 Vesicoureteral-reflux with reflux nephropathy with hydroureter, unilateral
N30.10 Interstitial cystitis (chronic) without hematuria
N30.11 Interstitial cystitis (chronic) with hematuria
N31.0 Uninhibited neuropathic bladder, not elsewhere classified
N31.1 Reflex neuropathic bladder, not elsewhere classified
N31.2 Flaccid neuropathic bladder, not elsewhere classified
N31.8 Other neuromuscular dysfunction of bladder
N31.9 Neuromuscular dysfunction of bladder, unspecified
N32.0 Bladder-neck obstruction
N32.81 Overactive bladder
N35.010 Post-traumatic urethral stricture, male, meatal
N35.011 Post-traumatic bulbous urethral stricture
N35.012 Post-traumatic membranous urethral stricture
N35.013 Post-traumatic anterior urethral stricture
N35.014 Post-traumatic urethral stricture, male, unspecified
N35.021 Urethral stricture due to childbirth
N35.028 Other post-traumatic urethral stricture, female
N35.811 Other urethral stricture, male, meatal
N35.812 Other bulbous urethral stricture, male
N35.813 Other membranous urethral stricture, male
N35.814 Other anterior urethral stricture, male
N35.816 Other urethral stricture, male, overlapping sites
N35.819 Other urethral stricture, male, unspecified site
N35.82 Other urethral stricture, female
N36.0 Urethral fistula
N36.1 Urethral diverticulum
N36.41 Hypermobility of urethra
N36.42 Intrinsic sphincter deficiency (ISD)
N36.43 Combined hypermobility of urethra and intrinsic sphincter deficiency
N36.44 Muscular disorders of urethra
N36.8 Other specified disorders of urethra
N37 Urethral disorders in diseases classified elsewhere
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
N39.491 Coital incontinence
N39.492 Postural (urinary) incontinence
N39.498 Other specified urinary incontinence
N40.1 Benign prostatic hyperplasia with lower urinary tract symptoms
N40.3 Nodular prostate with lower urinary tract symptoms
N42.81 Prostatodynia syndrome
N42.82 Prostatosis syndrome
N42.83 Cyst of prostate
N42.89 Other specified disorders of prostate
N81.0 Urethrocele
N81.11 Cystocele, midline
N81.12 Cystocele, lateral
N81.2 Incomplete uterovaginal prolapse
N81.3 Complete uterovaginal prolapse
N81.6 Rectocele
N81.81 Perineocele
N81.89 Other female genital prolapse
N81.9 Female genital prolapse, unspecified
N82.0 Vesicovaginal fistula
N82.1 Other female urinary-genital tract fistulae
N99.110 Postprocedural urethral stricture, male, meatal
N99.111 Postprocedural bulbous urethral stricture, male
N99.112 Postprocedural membranous urethral stricture, male
N99.113 Postprocedural anterior bulbous urethral stricture, male
N99.12 Postprocedural urethral stricture, female
Q05.0 Cervical spina bifida with hydrocephalus
Q05.1 Thoracic spina bifida with hydrocephalus
Q05.2 Lumbar spina bifida with hydrocephalus
Q05.3 Sacral spina bifida with hydrocephalus
Q05.5 Cervical spina bifida without hydrocephalus
Q05.6 Thoracic spina bifida without hydrocephalus
Q05.7 Lumbar spina bifida without hydrocephalus
Q05.8 Sacral spina bifida without hydrocephalus
Q07.00 Arnold-Chiari syndrome without spina bifida or hydrocephalus
Q07.01 Arnold-Chiari syndrome with spina bifida
Q07.02 Arnold-Chiari syndrome with hydrocephalus
Q07.03 Arnold-Chiari syndrome with spina bifida and hydrocephalus
Q62.11 Congenital occlusion of ureteropelvic junction
Q62.12 Congenital occlusion of ureterovesical orifice
Q62.2 Congenital megaureter
Q62.39 Other obstructive defects of renal pelvis and ureter
Q64.11 Supravesical fissure of urinary bladder
Q64.2 Congenital posterior urethral valves
Q64.31 Congenital bladder neck obstruction
Q64.32 Congenital stricture of urethra
Q64.33 Congenital stricture of urinary meatus
Q64.39 Other atresia and stenosis of urethra and bladder neck
Q64.5 Congenital absence of bladder and urethra
Q64.6 Congenital diverticulum of bladder
Q64.71 Congenital prolapse of urethra
Q64.72 Congenital prolapse of urinary meatus
Q64.73 Congenital urethrorectal fistula
Q64.74 Double urethra
Q64.75 Double urinary meatus
Q64.79 Other congenital malformations of bladder and urethra
R30.0 Dysuria
R32 Unspecified urinary incontinence
R33.0 Drug induced retention of urine
R33.8 Other retention of urine
R33.9 Retention of urine, unspecified
R34 Anuria and oliguria
R35.0 Frequency of micturition
R35.1 Nocturia
R39.11 Hesitancy of micturition
R39.12 Poor urinary stream
R39.13 Splitting of urinary stream
R39.14 Feeling of incomplete bladder emptying
R39.16 Straining to void
S14.0XXA Concussion and edema of cervical spinal cord, initial encounter
S14.0XXD Concussion and edema of cervical spinal cord, subsequent encounter
S14.0XXS Concussion and edema of cervical spinal cord, sequela
S14.101A Unspecified injury at C1 level of cervical spinal cord, initial encounter
S14.101D Unspecified injury at C1 level of cervical spinal cord, subsequent encounter
S14.101S Unspecified injury at C1 level of cervical spinal cord, sequela
S14.102A Unspecified injury at C2 level of cervical spinal cord, initial encounter
S14.102D Unspecified injury at C2 level of cervical spinal cord, subsequent encounter
S14.102S Unspecified injury at C2 level of cervical spinal cord, sequela
S14.103A Unspecified injury at C3 level of cervical spinal cord, initial encounter
S14.103D Unspecified injury at C3 level of cervical spinal cord, subsequent encounter
S14.103S Unspecified injury at C3 level of cervical spinal cord, sequela
S14.104A Unspecified injury at C4 level of cervical spinal cord, initial encounter
S14.104D Unspecified injury at C4 level of cervical spinal cord, subsequent encounter
S14.104S Unspecified injury at C4 level of cervical spinal cord, sequela
S14.105A Unspecified injury at C5 level of cervical spinal cord, initial encounter
S14.105D Unspecified injury at C5 level of cervical spinal cord, subsequent encounter
S14.105S Unspecified injury at C5 level of cervical spinal cord, sequela
S14.106A Unspecified injury at C6 level of cervical spinal cord, initial encounter
S14.106D Unspecified injury at C6 level of cervical spinal cord, subsequent encounter
S14.106S Unspecified injury at C6 level of cervical spinal cord, sequela
S14.107A Unspecified injury at C7 level of cervical spinal cord, initial encounter
S14.107D Unspecified injury at C7 level of cervical spinal cord, subsequent encounter
S14.107S Unspecified injury at C7 level of cervical spinal cord, sequela
S14.108A Unspecified injury at C8 level of cervical spinal cord, initial encounter
S14.108D Unspecified injury at C8 level of cervical spinal cord, subsequent encounter
S14.108S Unspecified injury at C8 level of cervical spinal cord, sequela
S14.109A Unspecified injury at unspecified level of cervical spinal cord, initial encounter
S14.109D Unspecified injury at unspecified level of cervical spinal cord, subsequent encounter
S14.109S Unspecified injury at unspecified level of cervical spinal cord, sequela
S14.111A Complete lesion at C1 level of cervical spinal cord, initial encounter
S14.111D Complete lesion at C1 level of cervical spinal cord, subsequent encounter
S14.111S Complete lesion at C1 level of cervical spinal cord, sequela
S14.112A Complete lesion at C2 level of cervical spinal cord, initial encounter
S14.112D Complete lesion at C2 level of cervical spinal cord, subsequent encounter
S14.112S Complete lesion at C2 level of cervical spinal cord, sequela
S14.113A Complete lesion at C3 level of cervical spinal cord, initial encounter
S14.113D Complete lesion at C3 level of cervical spinal cord, subsequent encounter
S14.113S Complete lesion at C3 level of cervical spinal cord, sequela
S14.114A Complete lesion at C4 level of cervical spinal cord, initial encounter
S14.114D Complete lesion at C4 level of cervical spinal cord, subsequent encounter
S14.114S Complete lesion at C4 level of cervical spinal cord, sequela
S14.115A Complete lesion at C5 level of cervical spinal cord, initial encounter
S14.115D Complete lesion at C5 level of cervical spinal cord, subsequent encounter
S14.115S Complete lesion at C5 level of cervical spinal cord, sequela
S14.116A Complete lesion at C6 level of cervical spinal cord, initial encounter
S14.116D Complete lesion at C6 level of cervical spinal cord, subsequent encounter
S14.116S Complete lesion at C6 level of cervical spinal cord, sequela
S14.117A Complete lesion at C7 level of cervical spinal cord, initial encounter
S14.117D Complete lesion at C7 level of cervical spinal cord, subsequent encounter
S14.117S Complete lesion at C7 level of cervical spinal cord, sequela
S14.118A Complete lesion at C8 level of cervical spinal cord, initial encounter
S14.118D Complete lesion at C8 level of cervical spinal cord, subsequent encounter
S14.118S Complete lesion at C8 level of cervical spinal cord, sequela
S14.119A Complete lesion at unspecified level of cervical spinal cord, initial encounter
S14.119D Complete lesion at unspecified level of cervical spinal cord, subsequent encounter
S14.119S Complete lesion at unspecified level of cervical spinal cord, sequela
S14.121A Central cord syndrome at C1 level of cervical spinal cord, initial encounter
S14.121D Central cord syndrome at C1 level of cervical spinal cord, subsequent encounter
S14.121S Central cord syndrome at C1 level of cervical spinal cord, sequela
S14.122A Central cord syndrome at C2 level of cervical spinal cord, initial encounter
S14.122D Central cord syndrome at C2 level of cervical spinal cord, subsequent encounter
S14.122S Central cord syndrome at C2 level of cervical spinal cord, sequela
S14.123A Central cord syndrome at C3 level of cervical spinal cord, initial encounter
S14.123D Central cord syndrome at C3 level of cervical spinal cord, subsequent encounter
S14.123S Central cord syndrome at C3 level of cervical spinal cord, sequela
S14.124A Central cord syndrome at C4 level of cervical spinal cord, initial encounter
S14.124D Central cord syndrome at C4 level of cervical spinal cord, subsequent encounter
S14.124S Central cord syndrome at C4 level of cervical spinal cord, sequela
S14.125A Central cord syndrome at C5 level of cervical spinal cord, initial encounter
S14.125D Central cord syndrome at C5 level of cervical spinal cord, subsequent encounter
S14.125S Central cord syndrome at C5 level of cervical spinal cord, sequela
S14.126A Central cord syndrome at C6 level of cervical spinal cord, initial encounter
S14.126D Central cord syndrome at C6 level of cervical spinal cord, subsequent encounter
S14.126S Central cord syndrome at C6 level of cervical spinal cord, sequela
S14.127A Central cord syndrome at C7 level of cervical spinal cord, initial encounter
S14.127D Central cord syndrome at C7 level of cervical spinal cord, subsequent encounter
S14.127S Central cord syndrome at C7 level of cervical spinal cord, sequela
S14.128A Central cord syndrome at C8 level of cervical spinal cord, initial encounter
S14.128D Central cord syndrome at C8 level of cervical spinal cord, subsequent encounter
S14.128S Central cord syndrome at C8 level of cervical spinal cord, sequela
S14.129A Central cord syndrome at unspecified level of cervical spinal cord, initial encounter
S14.129D Central cord syndrome at unspecified level of cervical spinal cord, subsequent encounter
S14.129S Central cord syndrome at unspecified level of cervical spinal cord, sequela
S14.131A Anterior cord syndrome at C1 level of cervical spinal cord, initial encounter
S14.131D Anterior cord syndrome at C1 level of cervical spinal cord, subsequent encounter
S14.131S Anterior cord syndrome at C1 level of cervical spinal cord, sequela
S14.132A Anterior cord syndrome at C2 level of cervical spinal cord, initial encounter
S14.132D Anterior cord syndrome at C2 level of cervical spinal cord, subsequent encounter
S14.132S Anterior cord syndrome at C2 level of cervical spinal cord, sequela
S14.133A Anterior cord syndrome at C3 level of cervical spinal cord, initial encounter
S14.133D Anterior cord syndrome at C3 level of cervical spinal cord, subsequent encounter
S14.133S Anterior cord syndrome at C3 level of cervical spinal cord, sequela
S14.134A Anterior cord syndrome at C4 level of cervical spinal cord, initial encounter
S14.134D Anterior cord syndrome at C4 level of cervical spinal cord, subsequent encounter
S14.134S Anterior cord syndrome at C4 level of cervical spinal cord, sequela
S14.135A Anterior cord syndrome at C5 level of cervical spinal cord, initial encounter
S14.135D Anterior cord syndrome at C5 level of cervical spinal cord, subsequent encounter
S14.135S Anterior cord syndrome at C5 level of cervical spinal cord, sequela
S14.136A Anterior cord syndrome at C6 level of cervical spinal cord, initial encounter
S14.136D Anterior cord syndrome at C6 level of cervical spinal cord, subsequent encounter
S14.136S Anterior cord syndrome at C6 level of cervical spinal cord, sequela
S14.137A Anterior cord syndrome at C7 level of cervical spinal cord, initial encounter
S14.137D Anterior cord syndrome at C7 level of cervical spinal cord, subsequent encounter
S14.137S Anterior cord syndrome at C7 level of cervical spinal cord, sequela
S14.138A Anterior cord syndrome at C8 level of cervical spinal cord, initial encounter
S14.138D Anterior cord syndrome at C8 level of cervical spinal cord, subsequent encounter
S14.138S Anterior cord syndrome at C8 level of cervical spinal cord, sequela
S14.139A Anterior cord syndrome at unspecified level of cervical spinal cord, initial encounter
S14.139D Anterior cord syndrome at unspecified level of cervical spinal cord, subsequent encounter
S14.139S Anterior cord syndrome at unspecified level of cervical spinal cord, sequela
S14.141A Brown-Sequard syndrome at C1 level of cervical spinal cord, initial encounter
S14.141D Brown-Sequard syndrome at C1 level of cervical spinal cord, subsequent encounter
S14.141S Brown-Sequard syndrome at C1 level of cervical spinal cord, sequela
S14.142A Brown-Sequard syndrome at C2 level of cervical spinal cord, initial encounter
S14.142D Brown-Sequard syndrome at C2 level of cervical spinal cord, subsequent encounter
S14.142S Brown-Sequard syndrome at C2 level of cervical spinal cord, sequela
S14.143A Brown-Sequard syndrome at C3 level of cervical spinal cord, initial encounter
S14.143D Brown-Sequard syndrome at C3 level of cervical spinal cord, subsequent encounter
S14.143S Brown-Sequard syndrome at C3 level of cervical spinal cord, sequela
S14.144A Brown-Sequard syndrome at C4 level of cervical spinal cord, initial encounter
S14.144D Brown-Sequard syndrome at C4 level of cervical spinal cord, subsequent encounter
S14.144S Brown-Sequard syndrome at C4 level of cervical spinal cord, sequela
S14.145A Brown-Sequard syndrome at C5 level of cervical spinal cord, initial encounter
S14.145D Brown-Sequard syndrome at C5 level of cervical spinal cord, subsequent encounter
S14.145S Brown-Sequard syndrome at C5 level of cervical spinal cord, sequela
S14.146A Brown-Sequard syndrome at C6 level of cervical spinal cord, initial encounter
S14.146D Brown-Sequard syndrome at C6 level of cervical spinal cord, subsequent encounter
S14.146S Brown-Sequard syndrome at C6 level of cervical spinal cord, sequela
S14.147A Brown-Sequard syndrome at C7 level of cervical spinal cord, initial encounter
S14.147D Brown-Sequard syndrome at C7 level of cervical spinal cord, subsequent encounter
S14.147S Brown-Sequard syndrome at C7 level of cervical spinal cord, sequela
S14.148A Brown-Sequard syndrome at C8 level of cervical spinal cord, initial encounter
S14.148D Brown-Sequard syndrome at C8 level of cervical spinal cord, subsequent encounter
S14.148S Brown-Sequard syndrome at C8 level of cervical spinal cord, sequela
S14.149A Brown-Sequard syndrome at unspecified level of cervical spinal cord, initial encounter
S14.149D Brown-Sequard syndrome at unspecified level of cervical spinal cord, subsequent encounter
S14.149S Brown-Sequard syndrome at unspecified level of cervical spinal cord, sequela
S14.151A Other incomplete lesion at C1 level of cervical spinal cord, initial encounter
S14.151D Other incomplete lesion at C1 level of cervical spinal cord, subsequent encounter
S14.151S Other incomplete lesion at C1 level of cervical spinal cord, sequela
S14.152A Other incomplete lesion at C2 level of cervical spinal cord, initial encounter
S14.152D Other incomplete lesion at C2 level of cervical spinal cord, subsequent encounter
S14.152S Other incomplete lesion at C2 level of cervical spinal cord, sequela
S14.153A Other incomplete lesion at C3 level of cervical spinal cord, initial encounter
S14.153D Other incomplete lesion at C3 level of cervical spinal cord, subsequent encounter
S14.153S Other incomplete lesion at C3 level of cervical spinal cord, sequela
S14.154A Other incomplete lesion at C4 level of cervical spinal cord, initial encounter
S14.154D Other incomplete lesion at C4 level of cervical spinal cord, subsequent encounter
S14.154S Other incomplete lesion at C4 level of cervical spinal cord, sequela
S14.155A Other incomplete lesion at C5 level of cervical spinal cord, initial encounter
S14.155D Other incomplete lesion at C5 level of cervical spinal cord, subsequent encounter
S14.155S Other incomplete lesion at C5 level of cervical spinal cord, sequela
S14.156A Other incomplete lesion at C6 level of cervical spinal cord, initial encounter
S14.156D Other incomplete lesion at C6 level of cervical spinal cord, subsequent encounter
S14.156S Other incomplete lesion at C6 level of cervical spinal cord, sequela
S14.157A Other incomplete lesion at C7 level of cervical spinal cord, initial encounter
S14.157D Other incomplete lesion at C7 level of cervical spinal cord, subsequent encounter
S14.157S Other incomplete lesion at C7 level of cervical spinal cord, sequela
S14.158A Other incomplete lesion at C8 level of cervical spinal cord, initial encounter
S14.158D Other incomplete lesion at C8 level of cervical spinal cord, subsequent encounter
S14.158S Other incomplete lesion at C8 level of cervical spinal cord, sequela
S14.159A Other incomplete lesion at unspecified level of cervical spinal cord, initial encounter
S14.159D Other incomplete lesion at unspecified level of cervical spinal cord, subsequent encounter
S14.159S Other incomplete lesion at unspecified level of cervical spinal cord, sequela
S24.0XXA Concussion and edema of thoracic spinal cord, initial encounter
S24.0XXD Concussion and edema of thoracic spinal cord, subsequent encounter
S24.0XXS Concussion and edema of thoracic spinal cord, sequela
S24.101A Unspecified injury at T1 level of thoracic spinal cord, initial encounter
S24.101D Unspecified injury at T1 level of thoracic spinal cord, subsequent encounter
S24.101S Unspecified injury at T1 level of thoracic spinal cord, sequela
S24.102A Unspecified injury at T2-T6 level of thoracic spinal cord, initial encounter
S24.102D Unspecified injury at T2-T6 level of thoracic spinal cord, subsequent encounter
S24.102S Unspecified injury at T2-T6 level of thoracic spinal cord, sequela
S24.103A Unspecified injury at T7-T10 level of thoracic spinal cord, initial encounter
S24.103D Unspecified injury at T7-T10 level of thoracic spinal cord, subsequent encounter
S24.103S Unspecified injury at T7-T10 level of thoracic spinal cord, sequela
S24.104A Unspecified injury at T11-T12 level of thoracic spinal cord, initial encounter
S24.104D Unspecified injury at T11-T12 level of thoracic spinal cord, subsequent encounter
S24.104S Unspecified injury at T11-T12 level of thoracic spinal cord, sequela
S24.109A Unspecified injury at unspecified level of thoracic spinal cord, initial encounter
S24.109D Unspecified injury at unspecified level of thoracic spinal cord, subsequent encounter
S24.109S Unspecified injury at unspecified level of thoracic spinal cord, sequela
S24.111A Complete lesion at T1 level of thoracic spinal cord, initial encounter
S24.111D Complete lesion at T1 level of thoracic spinal cord, subsequent encounter
S24.111S Complete lesion at T1 level of thoracic spinal cord, sequela
S24.112A Complete lesion at T2-T6 level of thoracic spinal cord, initial encounter
S24.112D Complete lesion at T2-T6 level of thoracic spinal cord, subsequent encounter
S24.112S Complete lesion at T2-T6 level of thoracic spinal cord, sequela
S24.113A Complete lesion at T7-T10 level of thoracic spinal cord, initial encounter
S24.113D Complete lesion at T7-T10 level of thoracic spinal cord, subsequent encounter
S24.113S Complete lesion at T7-T10 level of thoracic spinal cord, sequela
S24.114A Complete lesion at T11-T12 level of thoracic spinal cord, initial encounter
S24.114D Complete lesion at T11-T12 level of thoracic spinal cord, subsequent encounter
S24.114S Complete lesion at T11-T12 level of thoracic spinal cord, sequela
S24.119A Complete lesion at unspecified level of thoracic spinal cord, initial encounter
S24.119D Complete lesion at unspecified level of thoracic spinal cord, subsequent encounter
S24.119S Complete lesion at unspecified level of thoracic spinal cord, sequela
S24.131A Anterior cord syndrome at T1 level of thoracic spinal cord, initial encounter
S24.131D Anterior cord syndrome at T1 level of thoracic spinal cord, subsequent encounter
S24.131S Anterior cord syndrome at T1 level of thoracic spinal cord, sequela
S24.132A Anterior cord syndrome at T2-T6 level of thoracic spinal cord, initial encounter
S24.132D Anterior cord syndrome at T2-T6 level of thoracic spinal cord, subsequent encounter
S24.132S Anterior cord syndrome at T2-T6 level of thoracic spinal cord, sequela
S24.133A Anterior cord syndrome at T7-T10 level of thoracic spinal cord, initial encounter
S24.133D Anterior cord syndrome at T7-T10 level of thoracic spinal cord, subsequent encounter
S24.133S Anterior cord syndrome at T7-T10 level of thoracic spinal cord, sequela
S24.134A Anterior cord syndrome at T11-T12 level of thoracic spinal cord, initial encounter
S24.134D Anterior cord syndrome at T11-T12 level of thoracic spinal cord, subsequent encounter
S24.134S Anterior cord syndrome at T11-T12 level of thoracic spinal cord, sequela
S24.139A Anterior cord syndrome at unspecified level of thoracic spinal cord, initial encounter
S24.139D Anterior cord syndrome at unspecified level of thoracic spinal cord, subsequent encounter
S24.139S Anterior cord syndrome at unspecified level of thoracic spinal cord, sequela
S24.141A Brown-Sequard syndrome at T1 level of thoracic spinal cord, initial encounter
S24.141D Brown-Sequard syndrome at T1 level of thoracic spinal cord, subsequent encounter
S24.141S Brown-Sequard syndrome at T1 level of thoracic spinal cord, sequela
S24.142A Brown-Sequard syndrome at T2-T6 level of thoracic spinal cord, initial encounter
S24.142D Brown-Sequard syndrome at T2-T6 level of thoracic spinal cord, subsequent encounter
S24.142S Brown-Sequard syndrome at T2-T6 level of thoracic spinal cord, sequela
S24.143A Brown-Sequard syndrome at T7-T10 level of thoracic spinal cord, initial encounter
S24.143D Brown-Sequard syndrome at T7-T10 level of thoracic spinal cord, subsequent encounter
S24.143S Brown-Sequard syndrome at T7-T10 level of thoracic spinal cord, sequela
S24.144A Brown-Sequard syndrome at T11-T12 level of thoracic spinal cord, initial encounter
S24.144D Brown-Sequard syndrome at T11-T12 level of thoracic spinal cord, subsequent encounter
S24.144S Brown-Sequard syndrome at T11-T12 level of thoracic spinal cord, sequela
S24.149A Brown-Sequard syndrome at unspecified level of thoracic spinal cord, initial encounter
S24.149D Brown-Sequard syndrome at unspecified level of thoracic spinal cord, subsequent encounter
S24.149S Brown-Sequard syndrome at unspecified level of thoracic spinal cord, sequela
S24.151A Other incomplete lesion at T1 level of thoracic spinal cord, initial encounter
S24.151D Other incomplete lesion at T1 level of thoracic spinal cord, subsequent encounter
S24.151S Other incomplete lesion at T1 level of thoracic spinal cord, sequela
S24.152A Other incomplete lesion at T2-T6 level of thoracic spinal cord, initial encounter
S24.152D Other incomplete lesion at T2-T6 level of thoracic spinal cord, subsequent encounter
S24.152S Other incomplete lesion at T2-T6 level of thoracic spinal cord, sequela
S24.153A Other incomplete lesion at T7-T10 level of thoracic spinal cord, initial encounter
S24.153D Other incomplete lesion at T7-T10 level of thoracic spinal cord, subsequent encounter
S24.153S Other incomplete lesion at T7-T10 level of thoracic spinal cord, sequela
S24.154A Other incomplete lesion at T11-T12 level of thoracic spinal cord, initial encounter
S24.154D Other incomplete lesion at T11-T12 level of thoracic spinal cord, subsequent encounter
S24.154S Other incomplete lesion at T11-T12 level of thoracic spinal cord, sequela
S24.159A Other incomplete lesion at unspecified level of thoracic spinal cord, initial encounter
S24.159D Other incomplete lesion at unspecified level of thoracic spinal cord, subsequent encounter
S24.159S Other incomplete lesion at unspecified level of thoracic spinal cord, sequela
S34.01XA Concussion and edema of lumbar spinal cord, initial encounter
S34.01XD Concussion and edema of lumbar spinal cord, subsequent encounter
S34.01XS Concussion and edema of lumbar spinal cord, sequela
S34.02XA Concussion and edema of sacral spinal cord, initial encounter
S34.02XD Concussion and edema of sacral spinal cord, subsequent encounter
S34.02XS Concussion and edema of sacral spinal cord, sequela
S34.101A Unspecified injury to L1 level of lumbar spinal cord, initial encounter
S34.101D Unspecified injury to L1 level of lumbar spinal cord, subsequent encounter
S34.101S Unspecified injury to L1 level of lumbar spinal cord, sequela
S34.102A Unspecified injury to L2 level of lumbar spinal cord, initial encounter
S34.102D Unspecified injury to L2 level of lumbar spinal cord, subsequent encounter
S34.102S Unspecified injury to L2 level of lumbar spinal cord, sequela
S34.103A Unspecified injury to L3 level of lumbar spinal cord, initial encounter
S34.103D Unspecified injury to L3 level of lumbar spinal cord, subsequent encounter
S34.103S Unspecified injury to L3 level of lumbar spinal cord, sequela
S34.104A Unspecified injury to L4 level of lumbar spinal cord, initial encounter
S34.104D Unspecified injury to L4 level of lumbar spinal cord, subsequent encounter
S34.104S Unspecified injury to L4 level of lumbar spinal cord, sequela
S34.105A Unspecified injury to L5 level of lumbar spinal cord, initial encounter
S34.105D Unspecified injury to L5 level of lumbar spinal cord, subsequent encounter
S34.105S Unspecified injury to L5 level of lumbar spinal cord, sequela
S34.109A Unspecified injury to unspecified level of lumbar spinal cord, initial encounter
S34.109D Unspecified injury to unspecified level of lumbar spinal cord, subsequent encounter
S34.109S Unspecified injury to unspecified level of lumbar spinal cord, sequela
S34.111A Complete lesion of L1 level of lumbar spinal cord, initial encounter
S34.111D Complete lesion of L1 level of lumbar spinal cord, subsequent encounter
S34.111S Complete lesion of L1 level of lumbar spinal cord, sequela
S34.112A Complete lesion of L2 level of lumbar spinal cord, initial encounter
S34.112D Complete lesion of L2 level of lumbar spinal cord, subsequent encounter
S34.112S Complete lesion of L2 level of lumbar spinal cord, sequela
S34.113A Complete lesion of L3 level of lumbar spinal cord, initial encounter
S34.113D Complete lesion of L3 level of lumbar spinal cord, subsequent encounter
S34.113S Complete lesion of L3 level of lumbar spinal cord, sequela
S34.114A Complete lesion of L4 level of lumbar spinal cord, initial encounter
S34.114D Complete lesion of L4 level of lumbar spinal cord, subsequent encounter
S34.114S Complete lesion of L4 level of lumbar spinal cord, sequela
S34.115A Complete lesion of L5 level of lumbar spinal cord, initial encounter
S34.115D Complete lesion of L5 level of lumbar spinal cord, subsequent encounter
S34.115S Complete lesion of L5 level of lumbar spinal cord, sequela
S34.119A Complete lesion of unspecified level of lumbar spinal cord, initial encounter
S34.119D Complete lesion of unspecified level of lumbar spinal cord, subsequent encounter
S34.119S Complete lesion of unspecified level of lumbar spinal cord, sequela
S34.121A Incomplete lesion of L1 level of lumbar spinal cord, initial encounter
S34.121D Incomplete lesion of L1 level of lumbar spinal cord, subsequent encounter
S34.121S Incomplete lesion of L1 level of lumbar spinal cord, sequela
S34.122A Incomplete lesion of L2 level of lumbar spinal cord, initial encounter
S34.122D Incomplete lesion of L2 level of lumbar spinal cord, subsequent encounter
S34.122S Incomplete lesion of L2 level of lumbar spinal cord, sequela
S34.123A Incomplete lesion of L3 level of lumbar spinal cord, initial encounter
S34.123D Incomplete lesion of L3 level of lumbar spinal cord, subsequent encounter
S34.123S Incomplete lesion of L3 level of lumbar spinal cord, sequela
S34.124A Incomplete lesion of L4 level of lumbar spinal cord, initial encounter
S34.124D Incomplete lesion of L4 level of lumbar spinal cord, subsequent encounter
S34.124S Incomplete lesion of L4 level of lumbar spinal cord, sequela
S34.125A Incomplete lesion of L5 level of lumbar spinal cord, initial encounter
S34.125D Incomplete lesion of L5 level of lumbar spinal cord, subsequent encounter
S34.125S Incomplete lesion of L5 level of lumbar spinal cord, sequela
S34.129A Incomplete lesion of unspecified level of lumbar spinal cord, initial encounter
S34.129D Incomplete lesion of unspecified level of lumbar spinal cord, subsequent encounter
S34.129S Incomplete lesion of unspecified level of lumbar spinal cord, sequela
S34.131A Complete lesion of sacral spinal cord, initial encounter
S34.131D Complete lesion of sacral spinal cord, subsequent encounter
S34.131S Complete lesion of sacral spinal cord, sequela
S34.132A Incomplete lesion of sacral spinal cord, initial encounter
S34.132D Incomplete lesion of sacral spinal cord, subsequent encounter
S34.132S Incomplete lesion of sacral spinal cord, sequela
S34.139A Unspecified injury to sacral spinal cord, initial encounter
S34.139D Unspecified injury to sacral spinal cord, subsequent encounter
S34.139S Unspecified injury to sacral spinal cord, sequela
S34.3XXA Injury of cauda equina, initial encounter
S34.3XXD Injury of cauda equina, subsequent encounter
S34.3XXS Injury of cauda equina, sequela
T79.5XXA Traumatic anuria, initial encounter
T79.5XXD Traumatic anuria, subsequent encounter
T79.5XXS Traumatic anuria, sequela
N/A

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

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

ICD-10-PCS Codes

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

Additional ICD-10 Information

N/A

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.

Code Description
N/A

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.

Code Description
N/A

Other Coding Information

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

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Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A N/A
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Non-Excluded CPT/HCPCS Ended Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A

Revision History Information

Revision History Date Revision History Number Revision History Explanation
10/01/2023 R3

Due to the annual ICD-10 Code updates, ICD-10 code G20 has been deleted and the following ICD-10 codes have been added: G20.A1, G20.A2, G20.B1, G20.B2 and G20.C.

The code description was changed for ICD-10 code N35.812. 

06/01/2023 R2

CPT code 55899 has been added to the CPT/HCPCS Codes section, Group 1.

The following language has been added to the Article Text section and to the Group 1 paragraph of the CPT/HCPCS Code section: “If a penile pressure cuff is used when providing a voiding pressure study, CPT Code 55899 should be reported with non-invasive urodynamic studies noted in the narrative portion of the claim.

The following language was added to the CPT/HCPCS Code section- Group 1 paragraph “CPT Code 55899 should only be used if a penile pressure cuff is used when providing a voiding pressure study.”

05/05/2022 R1

Due to a provider request, ICD-10 codes N81.2 and N81.3 have been added to Group 1 of the "ICD-10-CM Codes that Support Medical Necessity" section, effective for dates of service on or after 05/05/2022.

N/A

Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
LCDs
L33576 - Urodynamics
Related National Coverage Documents
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SAD Process URL 1
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SAD Process URL 2
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Statutory Requirements URLs
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Rules and Regulations URLs
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CMS Manual Explanations URLs
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Other URLs
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Public Versions
Updated On Effective Dates Status
09/22/2023 10/01/2023 - N/A Currently in Effect You are here
05/24/2023 06/01/2023 - 09/30/2023 Superseded View
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

  • Urodynamics
  • Cystometrogram
  • Uroflowmetry
  • Urethral pressure profile
  • Sphincter electromyogram
  • Stimulus-evoked response
  • Incontinence
  • Voiding dysfunction