Does R35.81 require prior authorization?

No, R35.81 does not require prior authorization (high confidence). Covered without prior authorization.

`R35.81`, Nocturnal polyuria

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

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.

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).
Bladder ultrasound (bladder scan) is covered to measure post-void residual (PVR) urine volume to assess post-void urinary bladder retention.
Bladder ultrasound for PVR is covered as part of diagnosis and ongoing management of lower urinary tract dysfunctions, including urinary incontinence and neurogenic bladder, when results will inform clinical management.

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

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

Ask Backwork about documentation requirements, denial risks, or coverage in your state.