Billing and Coding: Urodynamics

Urodynamic procedures (CPTs 51725–51797 series) are covered when medically necessary to evaluate bladder and urethral function — for example, to assess detrusor activity, bladder compliance, post-void residual, outlet obstruction, or suspected neurogenic causes such as cauda equina. Claims must include valid ICD-10-CM codes, supporting clinical documentation (history, exam, test results), and required ordering/referring information; ABN and modifier rules (GA/GX/GY/GZ) and Part A/B billing distinctions apply. Follow NCCI/OPPS and LCD L34056 for coding edits, bundling, and any frequency limitations.

"Cystometrogram (CPT 51725, 51726) is covered when performed to evaluate detrusor contractions, abnormalities of bladder compliance, measure post-void residual, determine bladder capacity, or detect..."

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