Does R39.198 require prior authorization?

No, R39.198 does not require prior authorization (high confidence). Covered without prior authorization.

`R39.198`, Other difficulties with micturition

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).
There are complications such as, but not limited to, infection or implant site pain.
The device has been determined to be an ineffective treatment for the individualâs symptoms;or
There are complications such as, but not limited to, infection or implant site pain.
Removal of an implanted sacral nerve stimulator is consideredmedically necessarywhen any of the following have been met:
The device is no longer functioning appropriately;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-SURG-95, Sacral Nerve Stimulation for Urinary Retention, Urinary Incontinence, and Fecal Incontinence

ANTHEM-CG-SURG-126, Tibial Nerve Stimulation

ANTHEM-CG-LAB-28

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