**Abstract:**  
  
Urodynamic studies have become an increasingly important part of the
evaluation of voiding dysfunction. Cystometrogram, uroflowmetry, urethral
pressure profile, sphincter electromyogram, stimulus-evoked response, and
voiding pressure studies are used to identify abnormal voiding patterns in
symptomatic patients with disorders of urinary flow. Each of the urodynamic
studies has benefits and limitations that must be respected for each specific
clinical application.  
  
**Indications:**  
  
Urodynamic studies are indicated only after an initial evaluation is performed
that at minimum includes an appropriate history, physical exam, and urinalysis
with microscopy. Infection, if present, should be treated and effectiveness of
treatment observed before further diagnostic (urodynamic) testing or other
therapeutic interventions are undertaken.  
  
Urodynamic testing is covered under Medicare when medically necessary to
assist in the diagnosis of urologic dysfunction and when any of the following
apply:

  1. Uncertain diagnosis and inability to develop an appropriate treatment plan based on the basic diagnostic evaluation above.
  2. Failure to respond to an adequate therapeutic trial.
  3. Consideration of urologic surgical intervention, particularly if previous surgery failed or if the patient is a high surgical risk.
  4. Presence of other comorbid conditions such as incontinence associated with recurrent symptomatic urinary tract infection, persistent symptoms of difficult bladder emptying, history of previous anti-incontinence surgery or radical pelvic surgery, beyond hymen and symptomatic pelvic prolapse, prostate nodule, asymmetry or other suspicion of prostate cancer, abnormal post-void-residual urinalysis, and neurologic conditions affecting voiding function such as multiple sclerosis and spinal cord lesions or injury.

  
Manometric studies may be medically necessary when performed for
reconstruction of the ureter or obstruction of the ureter.  
  
**Limitations:**  
  

  1. Testing must be restricted to only those urodynamic testing procedures which are necessary to differentiate the etiology of the voiding dysfunction and must not consist of an entire battery of tests applied routinely to all patients.
  2. Payment for these procedures is predicated on the presence of signs and symptoms of voiding dysfunction that must be clearly documented in the medical record.
  3. The tests performed must be appropriate to analyze the patient's signs and symptoms or to guide further medical and/or surgical decision-making.
  4. The use of any of these procedures in a screening capacity does not represent a payable service.
  5. Pelvic descensus syndromes without urinary symptoms do not qualify for urodynamic testing.

  
Urinary flow rates determined by the patient at home and recorded for
physician evaluation are not eligible for Medicare reimbursement.  
  
 **Other Comments:**  
  
For claims submitted to the Part A MAC: this coverage determination also
applies within states outside the primary geographic jurisdiction with
facilities that have nominated CGS Administrators to process their claims.  
  
Bill type codes only apply to providers who bill these services to the Part A
MAC. Bill type codes do not apply to physicians, other professionals and
suppliers who bill these services to the carrier or Part B MAC.  
  
Limitation of liability and refund requirements apply when denials are likely,
whether based on medical necessity or other coverage reasons. The
provider/supplier must notify the beneficiary in writing, prior to rendering
the service, if the provider/supplier is aware that the test, item or
procedure may not be covered by Medicare. The limitation of liability and
refund requirements do not apply when the test, item or procedure is
statutorily excluded, has no Medicare benefit category or is rendered for
screening purposes.