Reimbursement

Please Read And Understand:

This information is retrieved from CMS Website (https://www.cms.gov/). It is provided as a courtesy for illustration purposes only. This does not in any way guarantee actual payment. Your local insurers may pay under their own guidelines. Review all information with your medical billing professionals.

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Urodynamics

Code

Short Description

 

2019

51726

Complex Cystometrogram

Total Payment

$ 286.15

 

 

Professional Interpretation

$ 88.66

 

 

Technical Component

$ 197.49

51727

Cystometrogram with UPP

Total Payment

$ 338.41

 

 

Professional Interpretation

$ 110.28

 

 

Technical Component

$ 228.13

51728

Cystometrogram with Voiding Pressure

Total Payment

$ 344.17

 

 

Professional Interpretation

$ 108.48

 

 

Technical Component

$ 235.70

51729

Cystometrogram with UPP and Voiding Pressure

Total Payment

$ 367.96

 

 

Professional Interpretation

$ 130.82

 

 

Technical Component

$ 237.14

51741

Complex Uroflowmetry

Total Payment

$ 14.78

 

 

Professional Interpretation

$ 8.65

 

 

Technical Component

$ 6.13

51784

Anal/urinary muscle study

Total Payment

$ 69.56

 

 

Professional Interpretation

$ 38.92

 

 

Technical Component

$ 30.63

51797

Intraabdominal pressure test

Total Payment

$ 142.35

 

 

Professional Interpretation

$ 41.81

 

 

Technical Component

$ 100.55

51701

Insert Bladder Catheter

Total Payment

$ 45.77

51798

Ultrasound Bladder Capacity

Total Payment

$ 12.97

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

Total Reimbursement per Patient: $487.98

PROCEDURE CPT CODE REIMBURSEMENT CALCULATION FEE
Complex CMG with Voiding Pressure Study 51728 $327.60 @ 100% $327.60
Uroflow 51741-51 $16.15 @ 50% $8.10
EMG 51784-51 $71.28 @ 50% $35.64
Voiding Pressure Test 51797* $116.64 @ 100% $116.64

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

Total Reimbursement per Patient: $512.10

PROCEDURE CPT CODE REIMBURSEMENT CALCULATION FEE
Complex CMG with Voiding Pressure Study & UPP 51729 $351.72 @ 100% $351.72
Uroflow 51741-51 $16.20 @ 50% $8.10
EMG 51784-51 $71.28 @ 50% $35.64
Voiding Pressure Test 51797* $116.64 @ 100% $116.64

*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.

51600

Injection for Bladder X-ray

Total Payment

$ 200.74

74430

Contrast X-ray, Bladder

Total Payment

$ 40.00

 

 

Professional Interpretation

$ 16.58

 

 

Technical Component

$ 23.43

74455

X-ray, Urethra/Bladder

Total Payment

$ 91.90

 

 

Professional Interpretation

$ 16.94

 

 

Technical Component

$ 74.96

76000

Fluoroscope Examination

Total Payment

$ 47.93

 

 

Professional Interpretation

$ 15.86

 

 

Technical Component

$ 32.07

Urgent PC Percutaneous Posterier Tibial Nerve Stimulation (PTNS)

Macroplastique (R)

ICD-10 Codes

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

GI ICD-10 Codes

CODE DESCRIPTION
K21.0 Gastro-esophageal reflux disease with esophagitis
K21.9 Gastro-esophageal reflux disease without esophagitis
K22.0 Achalasia of cardia
K30 Functional dyspepsia
K52.2 Allergic and dietetic gastroenteritis and colitis
K52.89 Other specified noninfective gastroenteritis and colitis
R11.0 Nausea
R11.10 Vomiting, unspecified
R11.11 Vomiting without nausea
R11.12 Projectile vomiting
R11.13 Vomiting of fecal matter
R11.14 Bilious vomiting
R11.2 Nausea with vomiting, unspecified
R12 Heartburn
R13.0 Aphagia
R13.10 Dysphagia, unspecified
R13.11 Dysphagia, oral phase
R13.12 Dysphagia, oropharyngeal phase
R13.13 Dysphagia, pharyngeal phase
R13.14 Dysphagia, pharyngoesophageal phase
R13.19 Other dysphagia
R14.0 Abdominal distension (gaseous)
R14.1 Gas pain
R14.2 Eructation
R14.3 Flatulence
R15.0 Incomplete defecation
R15.1 Fecal smearing
R15.2 Fecal urgency
R15.9 Full incontinence of feces
R19.11 Absent bowel sounds
R19.12 Hyperactive bowel sounds
R19.15 Other abnormal bowel sounds
R19.2 Visible peristalsis
R19.4 Change in bowel habit
R19.5 Other fecal abnormalities
R19.7 Diarrhea, unspecified
R19.8 Other specified symptoms and signs