Local Coverage Determination (LCD)

Post-Void Residual Urine and/or Bladder Capacity by Ultrasound

L34085

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Proposed LCD
Proposed LCDs are works in progress that are available on the Medicare Coverage Database site for public review. Proposed LCDs are not necessarily a reflection of the current policies or practices of the contractor.

Document Note

Note History

Contractor Information

LCD Information

Document Information

Source LCD ID
N/A
LCD ID
L34085
Original ICD-9 LCD ID
Not Applicable
LCD Title
Post-Void Residual Urine and/or Bladder Capacity by Ultrasound
Proposed LCD in Comment Period
N/A
Source Proposed LCD
N/A
Original Effective Date
For services performed on or after 10/01/2015
Revision Effective Date
For services performed on or after 03/02/2023
Revision Ending Date
N/A
Retirement Date
N/A
Notice Period Start Date
N/A
Notice Period End 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.

Issue

Issue Description

This LCD outlines limited coverage for this service with specific details under Coverage Indications, Limitations and/or Medical Necessity.

Issue - Explanation of Change Between Proposed LCD and Final LCD

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 Section 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 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.

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

Code of Federal Regulations:

42 CFR, Section 410.32, indicates that diagnostic tests may only be ordered by the treating physician (or other treating practitioner acting within the scope of his or her license and Medicare requirements) who furnishes a consultation or treats a beneficiary for a specific medical problem and who uses the results in the management of the beneficiary's specific medical problem. Tests not ordered by the physician (or other qualified non-physician provider) who is treating the beneficiary are not reasonable and necessary (see Sec. 411.15(k)(1) of this chapter).

CMS Publications:

CMS Manual System, Pub 100-4, Medicare Claims Processing Manual, Chapter 12:

    70 Payment conditions for radiology services

CMS Manual System, Pub 100-4, Medicare Claims Processing Manual, Chapter 13:

      20 Payment conditions for radiology services

 

    90 Services of portable X-Ray suppliers

CMS Manual System, Pub 100-4, Medicare Claims Processing Manual, Chapter 23:

    20.9 Standards of medical surgical practice and the correct coding initiative (CCI).

Coverage Guidance

Coverage Indications, Limitations, and/or Medical Necessity

Abstract:

Post-void residual (PVR) urine volume is the volume of urine in the bladder immediately after the completion of voiding. The standard method of determining PVR urine volumes is intermittent catheterization, which is associated with increased risk of urinary infection, urethral trauma and discomfort for the patient. Bladder ultrasound has been introduced as an alternative, noninvasive method, to avoid the potential complications of intermittent catheterization.

Bladder ultrasound or bladder scan to determine post-void residual urine employs either a standard ultrasound machine or a portable, battery-powered ultrasound device which consists of a hand-held ultrasound transducer (scanhead) and a base unit with a display screen. This unit automatically calculates and displays the bladder volume. This LCD defines Medicare coverage for the test.

Indications:

Bladder scan ultrasonography is utilized to assess post-void urinary bladder retention. It can be an important component in the diagnosis and ongoing management of lower urinary tract dysfunctions, including, but not limited to, urinary incontinence and/or neurogenic bladder.

When ultrasound measurement for post-void residual is the only service clinically indicated and/or rendered, it is inappropriate to report a pelvic ultrasound code (76856 or 76857) instead of, or in addition to, this service. Likewise, if a pelvic ultrasound code is appropriately billed, it is inappropriate to bill separately for the PVR measurement since payment for this has already been included in the payment of the pelvic study.

Limitations:

Routine ultrasound examination of incontinent patients in nursing homes and skilled nursing facilities is not warranted. PVR determination is only one component of incontinence evaluation. The patient must be capable of participating in the complete evaluation process and in the treatment plan in order for this testing to be appropriate. The use of ultrasound to measure PVR is not medically necessary if no treatment is planned, regardless of the findings.

The use of both ultrasound and catheterization during the same session to determine PVR is not medically necessary.

Other Comments:

For claims submitted to the Part A MAC: this coverage determination also applies within states outside the primary geographic jurisdiction with facilities that have nominated CGS Administrators to process their claims.

Bill type codes only apply to providers who bill these services to the Part A MAC. Bill type codes do not apply to physicians, other professionals and suppliers who bill these services to the carrier or Part B MAC.

Limitation of liability and refund requirements apply when denials are likely, whether based on medical necessity or other coverage reasons. The provider/supplier must notify the beneficiary in writing, prior to rendering the service, if the provider/supplier is aware that the test, item or procedure may not be covered by Medicare. The limitation of liability and refund requirements do not apply when the test, item or procedure is statutorily excluded, has no Medicare benefit category or is rendered for screening purposes.

For dates of service on or after April 1, 2010, bill type 77X should be used to report FQHC services.

Summary of Evidence

N/A

Analysis of Evidence (Rationale for Determination)

N/A

Proposed Process Information

Synopsis of Changes
Changes Fields Changed
N/A
Associated Information
Sources of Information
Bibliography
Open Meetings
Meeting Date Meeting States Meeting Information
N/A
Contractor Advisory Committee (CAC) Meetings
Meeting Date Meeting States Meeting Information
N/A
MAC Meeting Information URLs
N/A
Proposed LCD Posting Date
Comment Period Start Date
Comment Period End Date
Reason for Proposed LCD
Requestor Information
This request was MAC initiated.
Requestor Name Requestor Letter
N/A
Contact for Comments on Proposed LCD

Coding Information

Bill Type Codes

Code Description
N/A

Revenue Codes

Code Description
N/A

CPT/HCPCS Codes

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

Group 1 Paragraph:

N/A

Group 1 Codes:

N/A

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

Additional ICD-10 Information

General Information

Associated Information

Utilization Parameters 
CPT code 51798 (Measurement of post-voiding residual urine and/or bladder capacity by ultrasound, non-imaging) should not be performed more than once per day.

Services that exceed this parameter will be considered not medically necessary.

Sources of Information
This bibliography presents those sources that were obtained during the development of this policy. CGS Administrators is not responsible for the continuing viability of Web site addresses listed below.

Anton HA, Chambers K, Clifton J, Tasaka J. Clinical utility of a portable ultrasound device in intermittent catheterization. Archives of Physical Medicine and Rehabilitation. 1998;79:172-175.

Coombes GM, Millard RJ. The accuracy of portable ultrasound scanning in the measurement of residual urine volume. The Journal of Urology. 1994;152:2083-2085.

Empire Medicare Services New Jersey Medical Director.

Moore D, Edwards K. Using a portable bladder scan to reduce the incidence of nosocomial urinary tract infection. MedSurg Nursing. 1997;6(1):39-43.

New Jersey Carrier Advisory Committee.

New York State Urological Society.

NIH Consensus Statement Online. Urinary incontinence in adults. 1988 (cited March 2000);7(5):1-32.

Other Medicare Carriers’ policies – New York, Pennsylvania, Virginia.

Revord JP, Opitz JL, Murtaugh P, Harrison J. Determining residual urine volume using a portable ultrasonographic device. Archives of Physical Medicine and Rehabilitation. 1993;74:457-462.

Stam HJ, Rijst HVD, Bangma BD. Ultrasonic determination of bladder volume in patients with spinal cord injury. International Journal of Rehabilitation. 1991;14:256-260.
Bibliography

N/A

Revision History Information

Revision History Date Revision History Number Revision History Explanation Reasons for Change
03/02/2023 R10

R11

Revision Effective: 03/02/2023

Revision Explanation: Annual review, updated Associated Information section.

02/23/2023: At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy.

  • Other (Annual Review)
03/03/2022 R9

R10

Revision Effective: 03/03/2022

Revision Explanation: Annual review, no changes were made.

02/23/2022: At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy.

  • Other (Annual Review)
03/04/2021 R8

R9

Revision Effective: 03/04/2021

Revision Explanation: Annual review, no changes were made.

02/24/2021: At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy.

  • Other (Annual Review)
10/01/2016 R7

R8

Revision Effective: 09/26/2019 Revision Explanation: Converted to new policy template that no longer includes coding section based on CR 10901.

09/20/2019:At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy.

  • Revisions Due To Code Removal
10/01/2016 R6

R7

Revision Effective: N/A

Revision Explanation: Annual review no changes made.

02/27/2019:At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy.

  • Other (Annual Review)
10/01/2016 R5

R6
Revision Effective: N/A
Revision Explanation: Annual review no changes made.

02/26/2018:At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy.

  • Other (Annual Review)
10/01/2016 R4 R5
Revision Effective: N/A
Revision Explanation: Annual review no changes made.
  • Other (annual review)
10/01/2016 R3 R4
Revision Effective: 10/01/2016
Revision Explanation: During ICD-10 annual review R39.19 was deleted and replaced with R39.191, r39.192, R39.198.
  • Revisions Due To ICD-10-CM Code Changes
10/01/2015 R2 R3
Revision Effective: N/A
Revision Explanation: Annual review no changes made.
  • Other (Annual Review)
10/01/2015 R1 R1
Revision Effective: 10/01/2015
Revision: Accepted revenue code description changes.
  • Other (revenue code)
N/A

Associated Documents

Attachments
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Related National Coverage Documents
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Public Versions
Updated On Effective Dates Status
02/23/2023 03/02/2023 - N/A Currently in Effect You are here
02/23/2022 03/03/2022 - 03/01/2023 Superseded View
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

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