Does R39.198 require prior authorization?

No, R39.198 does not require prior authorization (high confidence). Code is covered without prior authorization.

`R39.198` — Other difficulties with micturition

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

There must be an attending/treating physician's order for each test documented in the patient's medical/clinical record prior to performing CPT 51798.
The patient's medical record must include the assessment related to the visit complaint, relevant medical history, physical examination, results of pertinent tests/procedures, plan of treatment, and signed and dated office visit or operative report.
Results documentation must show that the measurement was performed immediately post-void, include the date of the test, and identify the person who performed the test.
For services requiring a referring/ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim.

Measurement of post-void residual urine and/or bladder capacity by ultrasound (CPT 51798) is covered when ordered by the attending/treating/referring physician to evaluate a patient's urinary complaint and the medical record documents medical necessity (relevant history, physical exam, and supporting diagnostic results).
Bladder ultrasound (bladder scan) is covered to measure post-void residual (PVR) urine volume to assess post-void urinary bladder retention.
Bladder ultrasound for PVR is covered as part of diagnosis and ongoing management of lower urinary tract dysfunctions, including urinary incontinence and neurogenic bladder, when results will inform clinical management.
There are complications such as, but not limited to, infection or implant site pain.
The device has been determined to be an ineffective treatment for the individualâs symptoms;or
There are complications such as, but not limited to, infection or implant site pain.

ANTHEM-CG-SURG-95 — CG-SURG-95 Sacral Nerve Stimulation for Urinary Retention, Urinary Incontinence, and Fecal Incontinence

ANTHEM-CG-SURG-126 — CG-SURG-126 Tibial Nerve Stimulation

ANTHEM-CG-LAB-28 — CG-LAB-28 Prostate Specific Antigen Testing

A57050 — Billing and Coding: Post-Void Residual Urine and/or Bladder Capacity by Ultrasound

L34085 — Post-Void Residual Urine and/or Bladder Capacity by Ultrasound

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