CG-RAD-27 Scrotal Ultrasound

This policy addresses scrotal ultrasound (e.g., CPT 76870). It is medically necessary for evaluation of acute scrotal symptoms or trauma, scrotal asymmetry or enlargement (including suspected hydroceles), scrotal masses, and for detection/evaluation of varicoceles. It is not medically necessary for localization of undescended testes or for any other indications not listed.

"The use of scrotal ultrasound is consideredmedically necessaryfor the following conditions:"

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