UCR 065: FAQs - Rezum (53854) reimbursement; CPT 55866 denial; CPT 74425 when it's not billed with 50690; code for Renal Pelvic Washings

August 20, 2021

Mark, and Scott discuss questions from the Urology Coding and Reimbursement Group 

Question 1:  55 Seconds

Is Rezum (53854) reimbursement dropping in 2022?

Question 2 - minute 9:26

CPT 55866 was denied when billed with C67.9 and C67.2. It has an LCD/NCD that only lists dx codes related to gender identity. Surely those are not the only conditions that support medical necessity! Does anyone know how to appeal to a payer that denies for a more specific condition? Thanks for your help!

Question 3 - 13:50

I have received denials from Medicare on the CPT 74425 when it's not billed with 50690. They claim it's an add-on code even though it's not listed as such in any CPT book or website that I've found. I've also not been able to find an LCD or NCD for it. Does anyone else have this issue and if so, how did you proceed?  Thanks for your help! 

Question 4 - 15:19

Is there a cpt code for Renal Pelvic Washings?  

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