0597T — Temp fml iu valve-pmp rplcmt
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
1.02
Facility
$53.44
Non-Facility
$596.54
Documentation Required
- Treating practitioner must perform and document a clinical reevaluation between day 31 and day 91 after initiation of therapy to support continued medical necessity beyond the first 3 months.
- Documentation must demonstrate continued use of the device and that the individual is benefiting from the inFlow device.
- Clinical record must support the diagnosis of permanent urinary retention due to impaired detrusor contractility (as the basis for initial medical necessity).
- In-person encounter note from the treating practitioner documenting that the patient’s urinary symptoms have improved.
Key Coverage Criteria
- Intraurethral valve drainage device (e.g., inFlow™) is medically necessary as an alternative to intermittent catheterization for individuals with permanent urinary retention due to impaired detrusor contractility.
- Continued coverage of the inFlow device when an in-person re-evaluation documents that the patient’s urinary symptoms have improved.
- Continued coverage when the treating practitioner documents and verifies the patient’s adherence to use of the inFlow device.
- Impaired detrusor contractility (detrusor underactivity) causing permanent chronic urinary retention with inability to spontaneously void.
- Consideration of chronic bladder drainage management when the individual cannot void at all or cannot empty sufficiently to prevent urinary tract infections, overflow incontinence, bladder stones, or upper urinary tract damage.
- Intermittent catheterization for bladder management in patients with dysfunctional urinary elimination (DUA) who require daily catheter use.
5 Active Policies
BCBSIL-DME102.009 — Intraurethral Valve Drainage Device for Impaired Detrusor Contractility
BCBSMT-DME102.009 — Intraurethral Valve Drainage Device for Impaired Detrusor Contractility
BCBSNM-DME102.009 — Intraurethral Valve Drainage Device for Impaired Detrusor Contractility
BCBSOK-DME102.009 — Intraurethral Valve Drainage Device for Impaired Detrusor Contractility
DME102.009 — Intraurethral Valve Drainage Device for Impaired Detrusor Contractility
Related Codes
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