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HCPCS/CPT C1815, Prosthesis, urinary sphincter (implantable) | No Prior Auth

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`C1815`, Prosthesis, urinary sphincter (implantable)

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Key Coverage Criteria

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

1 Active Policy

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

Related Codes

51715(1 policies)53445(1 policies)53446(1 policies)53447(1 policies)53448(1 policies)

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