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Periureteral Bulking Agents as a Treatment of Vesicoureteral Reflux
Effective date
Not stated in the notice
Identified
Jun 20, 2026
Summary
Periureteral bulking agents may be considered medically necessary as a treatment of vesicoureteral reflux grades II, III, or IV when medical therapy has failed and surgical intervention is otherwise indicated. The use of bulking agents as a treatment of vesicoureteral reflux in other clinical situations is considered investigational. Bulking agents are contraindicated in individuals with nonfunctioning kidney(s), Hutch diverticuli, active voiding dysfunction, and ongoing urinary tract infection.
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What to do
Action · 4 steps
01Billing team: Before billing periureteral bulking agents for vesicoureteral reflux, confirm the reflux is grade II, III, or IV, that medical therapy has failed, and that surgical intervention is otherwise indicated.
02Do not bill bulking agents for vesicoureteral reflux in other clinical situations, which the policy considers investigational.
03Do not bill bulking agents for individuals with nonfunctioning kidney(s), Hutch diverticuli, active voiding dysfunction, or ongoing urinary tract infection, because the use is contraindicated for them.
04Claims for these services need documentation that the services are medically necessary, because no payment is made for services that are not documented to be medically necessary, and a provider's order or recommendation does not by itself make a service medically necessary.
Codes mentioned
52327L8603L8604L8606N13.70N13.739
Original notice
Periureteral Bulking Agents as a Treatment of Vesicoureteral Reflux
bcbsms.com · Always check the source before changing claims.