`C1815` Pros, urinary sph, imp

Prosthesis, urinary sphincter (implantable)

Medicare coverage: Special coverage instructions apply
Status: active (October 2026 file)

Medically Unlikely Edits (effective October 1, 2026)

Practitioner: max 1 units per day (clinical), rationale: Anatomic Consideration
Outpatient hospital: max 1 units per day (clinical), rationale: Anatomic Consideration

Payer policies and prior authorization for C1815

Payer coverage policies that name C1815

C1815 appears in 2 coverage policies from Aetna, Anthem.

Payer	Policy	Role in policy	Reviewed	Document
Aetna	Urinary Incontinence (0223)	covered if criteria are met	Jul 16, 2026	payer document
Anthem	Treatments for Urinary Incontinence (CG-SURG-134)	covered if criteria are met	May 14, 2026	payer document

Medicaid fee-for-service

Prior authorization required or conditional in IN.

KY: $0.00 (asc), effective Jan 1, 2026
ND: $0.00 (physician), effective Aug 1, 2026
OK: $0.00 (outpatient_hospital_apc), effective Jan 1, 2026
VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
WY: $0.00 (outpatient_hospital_apc, Children's Hospitals), effective Apr 1, 2026

From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.

C1815 Pros, urinary sph, imp

Medically Unlikely Edits (effective October 1, 2026)

Payer policies and prior authorization for C1815

Payer coverage policies that name C1815

Medicaid fee-for-service

`C1815` Pros, urinary sph, imp