2017 USA National Average Medicare Reimbursements

Reimbursement

PLEASE READ AND UNDERSTAND:

This information was retrieved from http://www.cms.gov/apps/physician-fee-schedule/search/search-criteria.aspx. It is provided as a courtesy for illustration purposes only. This does not in anyway guarantee actual payment. Your local insurers may pay under their own particular guidelines. Review all information with your medical billing professionals.

Urodynamics

+ 2017 CPT Codes

CPT Code Short Description 2017 Amounts
51726 Complex Cystometrogram Total Payment: $268.81
Professional Interpretation: $88.29
Technical Component: $180.52
51727 Cystometrogram with UPP Total Payment: $317.61
Professional Interpretation: $110.90
Technical Component: $206.72
51728 Cystometrogram with Voiding Pressure Total Payment: $321.20
Professional Interpretation: $108.38
Technical Component: $212.82
51729 Cystometrogam with UPP and Voiding Pressure Total Payment: $347.04
Professional Interpretation: $130.99
Technical Component: $216.05
51741 Electro-uroflowmetry, First Total Payment: $16.15
Professional Interpretation: $8.61
Technical Component: $7.54
51784 Anal/Urinary Muscle Study Total Payment: $70.70
Professional Interpretation: $38.76
Technical Component: $31.94
51797 Intraabdominal Pressure Test Total Payment: $114.13
Professional Interpretation: $41.63
Technical Component: $72.50
51701 Insert Bladder Catheter Total Payment: $48.45
51798 Ultrasound Bladder Capacity Total Payment: $19.74

+ Video Urodynamics

CPT CODE SHORT DESCRIPTION 2017 AMOUNTS
51600 Injection for Bladder X-ray Total Payment: $187.34
74430 Contrast X-ray, Bladder Total Payment: $38.40
Professional Interpretation: $16.51
Technical Component: $21.89
74455 X-ray, Urethra/Bladder Total Payment: $82.90
Professional Interpretation: $16.87
Technical Component: $66.04
76000 Fluoroscope Examination Total Payment: $48.09
Professional Interpretation: $8.97
Technical Component: $39.12

+ Medicare Reimbursements

If Doctor Performs Complex CMG with Voiding Pressure Study, EMG and Uroflow

Total Reimbursement per Patient: $478.76

Procedure CPT Code Reimbursement Calculation Fee
Complex CMG with Voiding Pressure Study 51728 $321.20 @ 100% $321.20
Uroflow 51741-51 $16.15 @ 50% $8.07
EMG 51784-51 $70.70 @ 50% $35.35
Voiding Pressure Test 51797* $114.13 @ 100% $114.13

If Doctor Performs Complex CMG with Voiding Pressure Study, Urethral Pressure Profile Study, EMG and Uroflow

Total Reimbursement per Patient: $504.60

PROCEDURE CPT CODE REIMBURSEMENT CALCULATION FEE
Complex CMG with Voiding Pressure Study & UPP 51729 $347.04 @ 100% $347.04
Uroflow 51741-51 $16.15 @ 50% $8.08
EMG 51784-51 $70.70 @ 50% $35.35
Voiding Pressure Test 51797* $114.13 @ 100% $114.13

*Code 51797 can only be billed if also billing either 51728 or 51729. 51797 is not billed with a -51 modifier as it is an add-on code to 51728 or 51729.

Anorectal Manometry

+ 2017 CPT Codes

CPT CODE SHORT DESCRIPTION 2017 AMOUNTS
91120 Rectal Sensation, Tone and Compliance Test Total Payment: $431.02
Professional Interpretation: $51.32
Technical Component: $379.70
91122 Anorectal Manometry Total Payment: $232.20
Professional Interpretation: $92.95
Technical Component: $139.25
51784 Anal/Urinary Muscle Study, EMG Total Payment: $70.70
Professional Interpretation: $38.76
Technical Component: $31.94

+ Medicare Reimbursements

Doctor Owns the Equipment

Total Reimbursement per Patient: $582.47

PROCEDURE CPT CODE REIMBURSEMENT CALCULATION FEE
Rectal Sensation and Compliance 91120 $431.02 @ 100% $431.02
Anorectal Manometry 91122-51 $232.20 @ 50% $116.10
Anal/Urinary Muscle Study, EMG 51784-51 $70.70 @ 50% $35.35

Hospital Owns the Equipment

Total Reimbursement per Patient: $117.18

PROCEDURE CPT CODE REIMBURSEMENT CALCULATION FEE
Rectal Sensation and Compliance 91120 $51.32 @ 100% $51.32
Anorectal Manometry 91122-26 $92.95 @ 50% $46.48
Anal/Urinary Muscle Study, EMG 51784-26 $38.76 @ 50% $19.38

Other Codes

CPT CODE SHORT DESCRIPTION 2017 AMOUNTS
76872 Transrectal ultrasound Total Payment: $96.90

Professional Interpretation: $34.09
Technical Component: $62.81

95907 1-2 Motor or Sensory nerve conduction study Total Payment: $99.05
Professional Interpretation: $54.91
Technical Component: $44.14

Pelvic Muscle Rehabilitation

+ 2016 CPT Codes

Medicare Reimbursement – The first 4 Weeks are the Documented Exercise prior to start of treatment.
Per visit billing outline*  (office)

1st Visit Total: $249.56

PROCEDURE CPT CODE REIMBURSEMENT CALCULATION FEE Time
Anorectal Manometry 91122 $229.51 @ 100% $229.51 3/4 to 1 Hour
Office Visit 99211-25 $92.02 @ 50% $46.01

2nd Visit Total: $234.16

PROCEDURE CPT CODE REIMBURSEMENT CALCULATION FEE
EMG 51784 $194.78 @ 100% $194.78
Office Visit 99211-25 $20.05 @ 100% $20.05
Electrical Stimulation 97032-GP $19.33 @ 100% $19.33

3rd Visit Total: $268.89

PROCEDURE CPT CODE REIMBURSEMENT CALCULATION FEE Time
Anorectal Manometry 91122 $229.51 @ 100% $229.51 3/4 to 1 Hour
Office Visit 99211-25 $20.05 @ 100% $20.05
Electrical Stimulation 97032-GP $19.33 @ 100% $19.33

4th Visit Total: $234.16

PROCEDURE CPT CODE REIMBURSEMENT CALCULATION FEE
EMG 51784 $194.78 @ 100% $194.78
Office Visit 99211-25 $20.05 @ 100% $20.05
Electrical Stimulation 97032-GP $19.33 @ 100% $19.33

“Prior to implementing biofeedback the patient must have failed a 4 week trial of prescribed pelvic floor muscle exercise.” [CMS Guidelines]

5th through 8th Visits Total: $157.54

PROCEDURE CPT CODE REIMBURSEMENT CALCULATION FEE Time
Biofeedback 90911 $84.86 @ 100% $84.86 20 min
Physical Performance 97750-GP $33.30 @ 100% $33.30
Electrical Stimulation 97032-GP $19.33 @ 100% $19.33
Office Visit 99211 $20.05 @ 100% $20.05

Other Procedures

CPT CODE SHORT DESCRIPTION 2016 AMOUNTS
51741 Electro-Uroflowmetry, First Total Payment: $16.11
51701 Insert Bladder Catheter Total Payment: $55.50
51798 Urine Capacity Measure by Ultrasound Total Payment: $19.33
51792 Bulbocavernosus Reflex Testing Total Payment: $214.11

Codes which may be utilized with appropriate provider and documentation in lieu of/or in addition to above coding*.

CPT CODE SHORT DESCRIPTION
99212-99214* (with appropriate provider) Evaluation and Management
97110* Therapeutic Instruction
97530* Therapeutic Exercise or Procedure (or)
97750* Physical Medicine Muscle
81000-81007* Urinalysis Contingent on CLIA License
97032/unit* Attended Stimulation

ICD-10 Codes

+ Sample Codes for Common Related Conditions

CODE DESCRIPTION
N32.3 Diverticulum of bladder / Diverticulitis of bladder
N32.81 Overactive bladder
N35 Urethral stricture
N36.1 Urethral diverticulum
N36.4 Urethral functional and muscular disorders
N36.42 Intrinsic sphincter deficiency (ISD)
N36.44 Muscular disorders of urethra
N39.0 Urinary tract infection, site not specified
N39.3 Stress incontinence; use additional code to identify overactive bladder or detrusor muscle hyperactivity
N39.41 Urge incontinence
N39.44 Nocturnal enuresis
N39.46 Mixed incontinence
N40.1 Enlarged prostate with lower urinary tract symptoms (LUTS)
R33 Retention of urine
R35 Polyuria, Frequency of micturition, Nocturia
R35.0 Urinary frequency
R35.1 Nocturia
R39.11 Hesitancy of micturition
R39.12 Poor urinary stream
R39.14 Feeling of incomplete bladder emptying
R39.15 Urgency of urination
R39.16 Straining to void
R39.81 Functional urinary incontinence
K59 Other functional intestinal disorders
K59.0 Constipation
K59.1 Functional diarrhea
K59.2 Neurogenic bowel, not elsewhere classified
K59.3 Megacolon, not elsewhere classified
K59.8 Other specified functional intestinal disorders
K59.9 Functional intestinal disorder, unspecified
K60 Fissure and fistula of anal and rectal regions
K62.9 Disease of anus and rectum, unspecified
K59 Other functional intestinal disorders