Urodynamics

Medicare covers urodynamic studies when medically necessary to diagnose or guide management of voiding dysfunction after an initial evaluation (history, physical exam, urinalysis with microscopy) and after any infection is treated. Coverage applies when basic evaluation is inconclusive, symptoms persist despite therapy, preoperative assessment is required (including prior failed surgery or high surgical risk), or specific comorbid conditions are present (e.g., recurrent UTIs, difficult bladder emptying, prior pelvic surgery, pelvic organ prolapse with symptoms, abnormal post-void residual, neurologic disease). Routine screening, tests without documented signs/symptoms, pelvic prolapse without urinary symptoms, and home-measured uroflow rates are not covered; documentation must clearly justify the tests performed.

"Urodynamic studies are indicated only after an initial evaluation that includes an appropriate history, physical examination, and urinalysis with microscopy."