Does 53452 require prior authorization?

No, 53452 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 53452?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Injection of periurethral bulking agents is consideredmedically necessarywhen the individual has stress urinary incontinence (SUI) meeting one the following two criteria (A or B):
The incontinence is due to trauma or injury;or
Both of the following are true (1 and 2):
The incontinence persists despite conservative treatment for at least a sufficient duration to fully assess treatment effect*;and
One of the following is true:The incontinence is caused by intrinsic sphincter deficiency (ISD),orThe incontinence is due to urethral hypermobility in individuals with abdominal leak point less than 100 cm H2O.
The incontinence is caused by intrinsic sphincter deficiency (ISD),or

ANTHEM-SURG.00010 — SURG.00010 Treatments for Urinary Incontinence

REGENCE-MED176 — Periurethral Transperineal Adjustable Balloon Continence Device

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