Urodynamic Testing  (CP.MP.98)

This policy covers urodynamic testing—including cystometrogram, uroflowmetry, urethral pressure profile and voiding pressure studies—to assess bladder storage and emptying when history and physical exam are insufficient, for conditions such as urinary incontinence, difficult bladder emptying, neurogenic bladder (e.g., MS, Parkinson’s, spinal cord injury), prior anti‑incontinence or radical pelvic surgery, symptomatic pelvic prolapse, suspected prostate pathology, or complex anorectal malformation. Limitations: testing is not routine screening in asymptomatic patients (except neurogenic bladder/complex anorectal malformation), is not required before conservative/noninvasive therapy, must follow initial evaluation and not be done during active UTI, is limited to one cystometrogram or uroflowmetry per visit, and requires appropriate ICD‑10 documentation (state Medicaid and contract terms apply).

"Urodynamic testing is medically necessary when diagnosis is uncertain and an appropriate initial treatment plan cannot be developed based on the clinical diagnostic evaluation."