Bladder scans (post-void residual measurement) — Billing and reimbursement policy
This billing policy describes coding, documentation, and reimbursement rules for bladder scans (ultrasound measurement of post-void residual urine) and applies to providers submitting claims to Priority Health.
Added 'Disclaimer' section
Coverage and Billing Rules
Coverage criteria and billing rules
Priority Health reimbursement and billing rules for bladder scans:
CPT and Coding Guidance
| 51798 | Measurement of post-voiding residual urine and/or bladder capacity by ultrasound, non-imaging |
| 76856 | Pelvic ultrasound, limited (used as reference — inappropriate to report in addition to 51798 when PVR is sole service) |
| 76857 | Pelvic ultrasound, complete (used as reference — inappropriate to report in addition to 51798 when PVR is sole service) |
Authorization, Medical Necessity, and Documentation
Obtain authorization and document medical necessity
Authorization and medical necessity are required for bladder scan services; having an authorization does not guarantee payment and does not override coding, billing or documentation requirements. Providers must follow applicable coding guidelines and fully document services in the medical record; failure to do so may result in claim denial, rejection, or payment recovery.
- Authorization requirements and medical necessity appropriate to procedure, diagnosis and frequency are still required.
- An authorization is not a guarantee of payment and does not supersede coding, billing or reimbursement requirements.
- Services must be performed and fully documented in the medical record to the highest level of specificity; failure to document will result in a denial.
Key Definitions
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.