Urinary Incontinence

Multichannel urodynamic studies are medically necessary when a patient has both symptoms and physical findings of urinary incontinence/voiding dysfunction and invasive or irreversible treatments are being considered after failure of conservative management; artificial urinary sphincter (AUS) implantation is medically necessary for intrinsic urethral sphincter deficiency in specified situations (children refractory to behavioral/pharmacologic therapy and unsuitable for other surgery; ≥6 months post‑prostatectomy with persistent UI despite behavioral and pharmacologic therapy; failed bladder‑neck reconstruction in epispadias‑exstrophy; and women with intractable UI after behavioral, pharmacologic, and surgical treatments). Exclusions/limits: AUS is investigational for other indications, periurethral bulking agents are investigational except for IUSD refractory to conservative care (and are not medically necessary after three failed injections), and implantable sacral nerve stimulators are investigational except for the listed urge‑UI/urge‑frequency and non‑obstructive retention criteria and are contraindicated if there was no response to test stimulation or the patient cannot operate the device.