Does R39.0 require prior authorization?

No, R39.0 does not require prior authorization (high confidence). Covered without prior authorization.

`R39.0`, Extravasation of urine

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).
Outpatient urine culture testing for bacteria is consideredmedically necessaryto evaluate any of the following situations:
Clinical signs or symptoms suggesting urinary tract infection (UTI);or
Abnormal urinalysis suggesting UTI;or
Asymptomatic bacteriuria in pregnant persons;or
Bacteriuria in individuals prior to undergoing an endoscopic urologic procedure;or

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

ANTHEM-CG-LAB-24, Outpatient Urine Culture

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.