Does 53860 require prior authorization?

No, 53860 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 53860?

Medicare facility rate: $201.74. Non-facility rate: $2391.50. Work RVU: 3.87.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

3.87

Facility

$201.74

Non-Facility

$2391.50

Baseline and follow-up clinical history and physical examinations (recommended at 1, 3, 6, and 12 months).
Urodynamic studies performed at baseline and during follow-up visits.
Voiding diary and validated quality-of-life questionnaire completed by the patient.
Objective outcome documentation: negative Valsalva maneuver defined as 'cure' and decreased daily pad use defined as 'improvement'.

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

BCBSIL-SUR710.021 — Radiofrequency Energy Therapy for Stress Urinary Incontinence

BCBSMT-SUR710.021 — Radiofrequency Energy Therapy for Stress Urinary Incontinence

BCBSNM-SUR710.021 — Radiofrequency Energy Therapy for Stress Urinary Incontinence

BCBSOK-SUR710.021 — Radiofrequency Energy Therapy for Stress Urinary Incontinence

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