Injectable bulking agents for urinary and fecal incontinence
Defines medical necessity and investigational coverage policy for periurethral (urinary) and perianal (fecal) injectable bulking agents, applicable to Commercial members (HMO, POS, PPO, Indemnity). Lists required CPT/HCPCS/ICD-10 codes, prior authorization rules for inpatient services, and summarizes evidence and approved/ investigational agents.
12/2024 annual policy review: References updated; policy statements unchanged.
3/2022 expansion: Medically necessary policy statement in men and women with stress urinary incontinence who have failed appropriate conservative therapy expanded.
8/2015 Contigen removed from medically necessary statement as it is no longer available; clarified coding information effective 8/1/2015.
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