Does 0499T require prior authorization?

No, 0499T does not require prior authorization (high confidence). Code is covered without prior authorization.

`0499T` — Cysto f/urtl strix/stenosis

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Objective confirmation of anterior urethral stricture length (≤3 cm) and diameter (≤12F) by cystoscopy or calibration.
Clinical history documenting at least two prior endoscopic treatments for the same stricture.
Baseline symptom score (IPSS) showing ≥11 and uroflowmetry documenting Qmax <15 mL/sec.
Procedure notes and follow-up cystoscopy/calibration results to document anatomic outcome and adverse events.

Treatment of obstructive urinary symptoms associated with urethral stricture using a drug‑coated urethral balloon.
Treatment of obstructive urinary symptoms associated with benign prostatic hyperplasia (BPH) using a drug‑coated urethral balloon to dilate the urethra and deliver paclitaxel.
Benign prostatic hyperplasia (BPH) in men, commonly age 60 and older, presenting with urinary frequency, weak or troubled urine stream, urinary retention, incontinence, recurrent urinary tract infections, or risk of bladder or kidney damage.
Urethral strictures causing obstruction of urinary flow (heading present in document).
Anterior urethral strictures causing progressive narrowing of the urethral lumen and symptoms consistent with bladder outlet obstruction.
Endoscopic treatment (dilation or urethrotomy) for urethral strictures, which is the primary treatment in approximately 95–98% of cases.

BCBSIL-SUR710.026 — Drug-Coated Urethral Balloon for Obstructive Urinary Symptoms

BCBSMT-SUR710.026 — Drug-Coated Urethral Balloon for Obstructive Urinary Symptoms

BCBSNM-SUR710.026 — Drug-Coated Urethral Balloon for Obstructive Urinary Symptoms

BCBSOK-SUR710.026 — Drug-Coated Urethral Balloon for Obstructive Urinary Symptoms

SUR710.026 — Drug-Coated Urethral Balloon for Obstructive Urinary Symptoms

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