Does 52260 require prior authorization?

No, 52260 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 52260?

Medicare facility rate: $185.71. Non-facility rate: $185.71. Work RVU: 3.81.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

3.81

Facility

$185.71

Non-Facility

$185.71

Verification of suprapubic catheter placement;or
Removal of indwelling ureteral stents not amenable to office-based procedure;or
Lower genital tract trauma with suspicion of urinary tract involvement, including urethral stricture;or
Urine dribbling post voiding (for example, from a urethral diverticulum);or
Injection of therapeutic agents for urinary incontinence;or
Outpatient cystourethroscopy is consideredmedically necessaryforanyof the following indications:

ANTHEM-CG-SURG-51 — CG-SURG-51 Outpatient Cystourethroscopy

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