CurrentFidelis CarePolicy FC.PP.MC.023

Urodynamic Testing

Defines Fidelis Care's coverage and reimbursement guidance for urodynamic studies for Medicare products, including CPT codes and ICD-10 diagnosis codes that are considered covered.

Policy Summary

PayerFidelis Care

PolicyUrodynamic Testing

Policy CodePolicy FC.PP.MC.023

Change TypeMinor/No material change

Effective Date

Next Review Date

Key ActionBill urodynamic testing with an ICD-10 diagnosis code listed in Table 2 for Medicare members to meet coverage criteria.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

MedicareProduct type covered

9CPT codes listed

ManyDiagnosis codes listed

CMS LCDsExternal references

Coverage Criteria for Urodynamic Testing

Coverage criteria

Covered when ALL of the following are met:

Urodynamic testing is covered for Medicare when billed with ICD-10 diagnosis codes listed in Table 2.

The service is billed using one of the CPT procedure codes listed in Table 1.

Providers should reference current coding guidance; CPT codes listed are informational and inclusion or exclusion does not guarantee coverage.

CPT and Diagnosis Codes

CPT codes considered covered (Table 1)CPTCovered

51725	Simple cystometrogram (CMG)(eg, spinal manometer).
51726	Complex cystometrogram (ie, calibrated electronic equipment).
51727	Complex cystometrogram (ie, calibrated electronic equipment); with urethral pressure profile studies (ie, urethral closure pressure profile), any technique.
51728	Complex cystometrogram (i.e., calibrated electronic equipment); with voiding pressure studies (ie, bladder voiding pressure), any technique.
51729	Complex cystometrogram (i.e., calibrated electronic equipment); with voiding pressure studies (ie, bladder voiding pressure) and urethral pressure profile studies (ie, urethral closure pressure profile), any technique.
51736	Simple uroflowmetry (UFR)(eg, stop-watch flow rate, mechanical uroflowmeter).
51741	Complex uroflowmetry (eg, calibrated electronic equipment).
51792	Stimulus evoked response (eg, measurement of bulbocavernosus reflex latency time).
51797	Voiding pressure studies, intra-abdominal (ie, rectal, gastric, intraperitoneal (List separately in addition to code for primary procedure)).

Policy Summary

PayerFidelis Care

PolicyUrodynamic Testing

Policy CodePolicy FC.PP.MC.023

Change TypeMinor/No material change

Effective Date

Next Review Date

Key ActionBill urodynamic testing with an ICD-10 diagnosis code listed in Table 2 for Medicare members to meet coverage criteria.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Definitions and Notes

CPT guidance note

Guidance summaryCPT codes referenced are informational; inclusion or exclusion of any codes does not guarantee coverage.

Provider responsibilityProviders should reference the most up-to-date sources of professional coding guidance prior to claim submission.

Source and copyrightCPT is a registered trademark of the American Medical Association; codes and descriptions are from current manuals and included for informational purposes only.

Scope of listCodes listed in the policy are not intended to be all-inclusive and are included for informational purposes only.

Health Plan

ApplicabilityApplies to plans that have formally adopted this payment policy; administration may be by Centene Management Company, LLC or affiliates.

Relationship to policyThe Health Plan adopts this payment policy as a guide to payment and coverage determinations but it does not by itself guarantee payment.

A18.13	Tuberculosis of other urinary organs.
A52.10	Symptomatic neurosyphilis.
A52.3	Neurosyphilis, unspecified.
A80.9	Acute poliomyelitis, unspecified.
C61	Malignant neoplasm of prostate.
C70.1	Malignant neoplasm of spinal meninges.
C72.0	Malignant neoplasm of spinal cord.
C72.1	Malignant neoplasm of cauda equina.
C79.82	Secondary malignant neoplasm of genital organs.
D29.1	Benign neoplasm of prostate.

OpenPayer

Urodynamic Testing

Coverage Criteria for Urodynamic Testing

CPT and Diagnosis Codes

Billing and Provider Guidance

Definitions and Notes