This information is provided by Laborie for reimbursement informational purposes only. This is not an affirmative instruction as to which codes and modifiers to use for a particular service or item. Any coding, coverage, and payment information contained herein is gathered from various resources and is subject to change without notice. It is always the provider’s responsibility to determine medical necessity, the proper site for delivery of any services and to submit appropriate codes, charges, and modifiers for services that are rendered. Laborie recommends that you consult with your payers, reimbursement specialists and/or legal counsel regarding coding, coverage and reimbursement matters.
2023 Uro CPT Codes and Medicare National Average Allowable Payment
| CPT™ Code1 |
Description | 20232 |
| 51726 | Complex Uroflowmetry ( eg, calibrated electronic Equipment) | $ 13.55 |
2023 Uro CPT Codes and Medicare National Average Allowable Payment
| CPT™ Code1 |
Description | 20232 |
| 51798 | Meausurement of post-voiding residual urine and or bladder capacity by ulrasound, non imaging | $ 10.24 |
2023 Uro CPT Codes and Medicare National Average Allowable Payment
| CPT™ Code1 |
Description | 20232 |
| 51728 | Complex cystometrogram (ie, calibrated electronic equipment) with voiding pressure studies (ie, bladder voiding pressure), any technique | $ 366.30 |
| 51741-51 | Complex uroflowmetry (eg, calibrated electronic equipment) | $ 6.77 |
| 51784-51 | Electromyography studies (EMG) of anal or uretral sphincter, other than needle, any technique | $31.40 |
| 51797* | Voiding pressure studies, intra-abdominal (ie, rectal, gastric, intraperitoneal) (List seperately in addition to code for primary procedure) | $195.71 |
| Total | $600.18 |
2023 Uro CPT Codes and Medicare National Average Allowable Payment
| CPT™ Code1 |
Description | 20232 |
| 51729 | Complex cystometrogram (ie, calibrated electronic equipment); with voiding pressure studies (ie, bladder voiding pressure) and urethral pressure profile studies (ie, urethral closure pressure profile), any technique | $ 387.13 |
| 51741-51 | Complex uroflowmetry (eg, calibrated electronic equipment) | $ 6.77 |
| 51784-51 | Electromyography studies (EMG) of anal or uretral sphincter, other than needle, any technique | $31.40 |
| 51797* | Voiding pressure studies, intra-abdominal (ie, rectal, gastric, intraperitoneal) (List seperately in addition to code for primary procedure) | $195.71 |
| Total | $621.01 |
* 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.
2023 Uro CPT Codes and Medicare National Average Allowable Payment
| CPT™ Code1 |
Description | 20232 |
| 51729 | Complex cystometrogram (ie, calibrated electronic equipment); with voiding pressure studies (ie, bladder voiding pressure) and urethral pressure profile studies (ie, urethral closure pressure profile), any technique | $ 387.13 |
| 51741-51 | Complex uroflowmetry (eg, calibrated electronic equipment) | $ 6.77 |
| 51784-51 | Electromyography studies (EMG) of anal or uretral sphincter, other than needle, any technique | $31.40 |
| 51797* | Voiding pressure studies, intra-abdominal (ie, rectal, gastric, intraperitoneal) (List seperately in addition to code for primary procedure) | $195.71 |
| 51600 | Injection procedure for cystography or voiding urethrocystography | $215.88 |
| 74455 | Urethrocystography, voiding, radiological supervision and interpratation | $105.13 |
| Total | $942.02 |
* 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.
2023 Uro CPT Codes and Medicare National Average Allowable Payment
| CPT™ Code1 |
Description | 20232 |
| 51728 | Complex cystometrogram (ie, calibrated electronic equipment) with voiding pressure studies (ie, bladder voiding pressure), any technique | $ 366.30 |
| 51741-51 | Complex uroflowmetry (eg, calibrated electronic equipment) | $ 6.77 |
| 51784-51 | Electromyography studies (EMG) of anal or uretral sphincter, other than needle, any technique | $31.40 |
| 51797* | Voiding pressure studies, intra-abdominal (ie, rectal, gastric, intraperitoneal) (List seperately in addition to code for primary procedure) | $195.71 |
| 51600 | Injection procedure for cystography or voiding urethrocystography | $215.88 |
| 74455 | Urethrocystography, voiding, radiological supervision and interpratation | $105.13 |
| Total | $921.19 |
* 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.
2023 Uro CPT Codes and Medicare National Average Allowable Payment
| CPT™ Code1 |
Description | 20232 |
| 91120 | Rectal sensation, tone, and compliance test (ie, response to graded balloon distention) | $ 524.99 |
| 91122 | Anorectal manometry | $ 278.55 |
| 51784-51 | Electromyography studies (EMG) of anal or uretral sphincter, other than needle, any technique | $31.40 |
The following tables provide CPT coding for the Optilume procedure and 2023 Medicare national average reimbursement for the physician, hospital outpatient, and ambulatory surgery center (ASC) settings of care. Payment will vary by geographic location. Private payers will pay based on contracted rates.
| 2023 Medicare National Average Payment |
||||
| CPT™ Code1 |
Description | Physician Facility2 |
Hospital Outpatient3 |
Ambulatory Surgery Center4 |
| 0499T | Cystourethroscopy, with mechanical dilation and urethral therapeutic drug delivery for urethral stricture or stenosis, including fluoroscopy, when performed |
Carrier Priced* | $3,205.12 | $1,496.56 |
Do not report 0499T in conjunction with 52281 or 52283.
*For most carrier-priced procedures, each Medicare Administrative (MAC) uses individual consideration when reviewing a carrier-priced procedure and may request medical records to assist in the evaluation and pricing. This occurs only after receipt of the claim. Therefore, providers who submit claims electronically should indicate that documentation is available upon request.
Possible Coding for Physician, Hospital Outpatient and Ambulatory Surgical Center (ASC)
The following tables provide Current Procedural Technology (CPT)1 codes, Healthcare Common Procedure Coding System (HCPCS)2 code and 2023 Medicare National Average Payment.
Evaluation and Management CPT codes (W/-25 Modifier)*
| New Patient | 99201-992051 | Office/outpatient visit, new patient 10-60 minutes |
| Existing Patient | 99211-992151 | Office/outpatient visit established patient 5-40 minutes |
Eclipse™ HCPCS Code and 2023 Medicare DMEPOS Reimbursement
Eclipse™ is reimbursed under Medicare Part B. Payment will vary by geographic location.
| HCPCS1 Code | Description | 2023 Medicare National Average Payment2 |
| A4563 | Rectal control system for vaginal insertion, for long term use, includes pump and all supplies and accessories, any type each. |
$1,556 |
*Review all key components listed for each E/M code and determine the most appropriate code, if any, for the visit based on the documented requirements from the AMA. The -25 modifier may be added to the E/M service to designate the fitting procedure was separate and distinct from the E/M services. A separate procedure note for the fitting is required and typically assigned to the diagnosis code describing the reason for the fitting.
2023 Uro CPT Codes and Medicare National Average Allowable Payment
| CPT™ Code1 |
Description | 20232 |
| 64566 | Posterior tibial neurostimulation, percutaneous needle electrode, single treatment, includes programming | $ 118.35 |
2023 Uro CPT Codes and Medicare National Average Allowable Payment
| CPT™ Code1 |
Description | 20232 |
| 51715 | Endoscopic injection of implant material into the submucosal tissues of the urethra and / or bladder neck ( billed 3 Units, this is per unit amount) | $ 370.93 |
| L86063 | Injectable bulking agent, synthetic implant, urinary tract, 1 ml syringe, includes shipping and necessary supplies | $ 246 |
| L86063 | Injectable bulking agent, synthetic implant, urinary tract, 1 ml syringe, includes shipping and necessary supplies (2 Units) $246 per unit | $ 492 |
2023 Uro CPT Codes and Medicare National Average Allowable Payment
| CPT™ Code1 |
Description | 20232 |
| 52000 | Cystourethoscopy (separate procedure) | $ 241.66 |
| 52310 | Stent Pull | $ 277.37 |
| 52204 | Cysto/Biopsy | $ 381.18 |
| 52287 | Cysto/Botox Injection | $ 389.77 |
| CODE5 | 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 |
| CODE5 | 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 |
You deserve the best care possible along your way to leading a more normal life, and Laborie offers diagnostic and therapeutic options along the treatment pathway.
