Back to Top Skip to main content

Health.mil: the official website of the Military Health System (MHS) and the Defense Health Agency (DHA)

Utility Navigation Links

Alert Arrow ALERT!!

MONTHLY MAINTENANCE: The DHA network is scheduled for monthly maintenance on Saturday, June 19th at 4 AM (MST) until Sunday, June 20th at 10 PM (MST). The TRICARE Manuals web site may be available intermittently during this period but its usage is not recommended.

TRICARE Policy Manual 6010.60-M, April 1, 2015
Chapter 4
Section 14.1
Urinary System
Issue Date:  August 26, 1985
Authority:  32 CFR 199.4(c)(2) and (c)(3)
Copyright:  CPT only © 2006 American Medical Association (or such other date of publication of CPT). All Rights Reserved.
Revision:  C-1, March 10, 2017
1.0  CPT PROCEDURE CODES
50010 - 53899, 64561, 64581, 64585, 64590, 64595
2.0  DESCRIPTION
The urinary system involves those organs concerned in the production and excretion of urine.
3.0  POLICY
3.1  Services and supplies required in the diagnosis and treatment of illness or injury involving the urinary system are covered.
3.2  Benefits may be considered for the implantation of similar U.S. Food and Drug Administration (FDA) approved devices. The Sacral Nerve Root Stimulation (SNS) has received FDA approval. Services and supplies related to the implantation of the SNS may be covered for individuals with urge incontinence, non-obstructive urinary retention, or symptoms of urgency-frequency syndrome that is not due to a neurologic condition, who have failed previous conservative treatments, and who have had a successful peripheral nerve evaluation test.
3.3  The use of a bedwetting alarm for the treatment of primary nocturnal enuresis may be considered for cost-sharing when prescribed by a physician and after physical or organic causes for nocturnal enuresis have been ruled out.
3.4  Collagen implantation of the uretha and/or bladder neck may be covered for patients not amenable to other forms of urinary incontinence treatment.
3.5  Cryoablation for renal cell carcinoma (Current Procedural Terminology (CPT) procedure codes 50250 and 50593) may be considered for coverage under the Rare Disease policy (Chapter 1, Section 3.1) on a case-by-case basis. Effective June 1, 2006.
3.6  Under the provisions for the treatment of rare diseases, coverage of laparoscopic Radiofrequency Ablation (RFA) (CPT procedure code 50542) and Percutaneous Radiofrequency Ablation (PRFA) (CPT procedure code 50592) may be considered on a case-by-case basis for the treatment of Renal Cell Carcinoma (RCC) and genetic syndromes associated with RCC including von Hippel-Lindau syndrome, hereditary papillary cell carcinoma, or hereditary clear-cell carcinoma for patients who are not appropriate candidates for surgical intervention.
3.7  Posterior Tibial Nerve Stimulation (PTNS) for treatment of overactive bladder, to include urinary frequency, urge, and incontinence (CPT code 64566) is proven.
3.8  Prostatic Urethral Lift (PUL) for the treatment of urinary outflow obstruction secondary to Benign Prostatic Hyperplasia (BPH) (CPT codes 52441, 52442; HCPCS codes C9739, C9740) is proven.
4.0  EXCLUSIONS
4.1  Peri-urethral Teflon injection is unproven.
4.2  Silastic gel implant.
4.3  Acrylic prosthesis (Berry prosthesis).
4.4  Bladder stimulators, direct or indirect, such as spinal cord, rectal and vaginal electrical stimulators, or bladder wall stimulators. Payment for any related service or supply, including inpatient hospitalization primarily for surgical implementation of a bladder stimulator.
4.5  Transurethral balloon dilation of the prostate (CPT procedure code 52510) is unproven.
4.6  Cryoablation for the treatment of renal angiomyolipoma is unproven.
5.0  EFFECTIVE DATE
5.1  Transurethral Needle Ablation (TUNA) of the prostate is proven (CPT procedure code 53852). Effective June 1, 2004.
5.2  March 28, 2007, for laparoscopic RFA or PRFA for the treatment of RCC and genetic syndromes associated with RCC, including von Hippel-Lindau syndrome, hereditary papillary cell carcinoma, or hereditary clear-cell carcinoma.
5.3  December 9, 2014, for PTNS for the treatment of overactive bladder.
5.4  September 16, 2015, for PUL for the treatment of urinary outflow obstruction secondary to BPH.
- END -

Utility Navigation Links

DoD Seal

tricare.mil is the official website of the Defense Health Agency (DHA) a component of the Military Health System

TRICARE is a registered trademark of the Department of Defense (DoD), DHA. All rights reserved.

CPT only © 2006 American Medical Association (or such other date of publication of CPT). All Rights Reserved.

If you have a question regarding TRICARE benefits, please go to the TRICARE Contact Us page page.
If you need help with technical/operational issues, please go to the TRICARE Manuals Online Frequently Asked Questions page.

The appearance of hyperlinks to external websites does not constitute endorsement by the DHA of these websites or the information, products or services contained therein. For other than authorized government activities, the DHA does not exercise any editorial control over the information you may find at other locations. Such links are provided consistent with the stated purpose of this DoD website.

v4.6.7755.23747

DHA Address: 7700 Arlington Boulevard | Suite 5101 | Falls Church, VA | 22042-5101

Some documents are presented in Portable Document Format (PDF). A PDF reader is required for viewing. Download a PDF Reader or learn more about PDFs.