Does R30.9 require prior authorization?

No, R30.9 does not require prior authorization (medium confidence). Covered without prior authorization by at least one policy, though another does not cover it.

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`R30.9`, Painful micturition, unspecified

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization by at least one policy, though another does not cover it (medium confidence)

Documentation Required

There must be an attending/treating physician's order for each test documented in the patient's medical/clinical record prior to performing CPT 51798.
The patient's medical record must include the assessment related to the visit complaint, relevant medical history, physical examination, results of pertinent tests/procedures, plan of treatment, and signed and dated office visit or operative report.
Results documentation must show that the measurement was performed immediately post-void, include the date of the test, and identify the person who performed the test.
For services requiring a referring/ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim.

Key Coverage Criteria

Measurement of post-void residual urine and/or bladder capacity by ultrasound (CPT 51798) is covered when ordered by the attending/treating/referring physician to evaluate a patient's urinary complaint and the medical record documents medical necessity (relevant history, physical exam, and supporting diagnostic results).
Non-obstetrical transvaginal ultrasound is considered medically necessary for the evaluation of suspected pelvic pathology.
Non-obstetrical transvaginal ultrasound is considered medically necessary for screening or surveillance of a woman at increased risk for ovarian or endometrial cancer.
Evaluation of unexplained bleeding in the postmenopausal woman (TVUS can suggest presence of polyps, abnormal endometrial histology such as adenomatous hyperplasia, or cancer).
Evaluation of a pelvic mass to provide information about the location of a pelvic mass relative to the ovary and uterus and to better delineate internal architectural characteristics.
Evaluation of patients with acute pelvic pain (TVUS can help rule out ovarian primary source for acute pain when ovaries appear normal and no free intraperitoneal fluid is present).

4 Active Policies

CGS-J15-L34085, Post-Void Residual Urine and/or Bladder Capacity by Ultrasound

J15

CGS-J18-L34085, Post-Void Residual Urine and/or Bladder Capacity by Ultrasound

J18

CIGNA-0398, Transvaginal Ultrasound, Non-Obstetrical

A57050, Billing and Coding: Post-Void Residual Urine and/or Bladder Capacity by Ultrasound

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R30.9, Painful micturition, unspecified