Additional Support Resources

Sample Claim Submission Letter: 51728 -52

Sample Claim Submission Letter: 53899

Non-invasive Summary of Supporting Evidence

2020 UroCuff Study

Sample Publication on Equivalence to Catheterized Voiding Pressure

Sample Predictor of BPH Procedures - 1

Sample Predictor of BPH Procedures - 2

Sample Appeal Letter: 51728 -52

Sample Appeal Letter: 53899

A Physician Dictation for UroCuff

Principles of the UroCuff Test

Summary of Supporting Evidence

SRS Coding Hotline
866-850-7607

Physician Office Coding

Coding & Billing

 CPT® Code

• 51720 – Bladder instillation of anticarcinogenic agent (including retention time)

HCPCS Codes

• J9999 – Antineoplastic drugs, not otherwise classified (recommended for Zusduri)

• Some payers may require: 

  • J3490 – Unclassified drugs

  • J3590 – Unclassified biologics

Box 19:
Use Box 19 to document the NDC number, drug name, route of administration, and dosage given. If billing with a miscellaneous code, record any drug wastage here.

Example: A patient receives 75 mg from an 80-mg vial. The remaining 5 mg should be documented as wastage.  So the Box 19 entry could be written like: 72493010603 ZUSDURI Instillation ME75 ME5JW

Important: Do not use J9280 (Mitomycin, 5 mg) for Zusduri.

ICD-10-CM Codes for Bladder Cancer

Pair C67.x site‑specific malignant neoplasm codes with treatment/encounter Z‑codes as appropriate.

• C67.0 – Malignant neoplasm of trigone of bladder

• C67.1 – Malignant neoplasm of dome of bladder

• C67.2 – Malignant neoplasm of lateral wall of bladder

• C67.3 – Malignant neoplasm of anterior wall of bladder

• C67.4 – Malignant neoplasm of posterior wall of bladder

• C67.5 – Malignant neoplasm of bladder neck

• C67.6 – Malignant neoplasm of ureteric orifice

• C67.7 – Malignant neoplasm of urachus

• C67.8 – Malignant neoplasm of overlapping sites of bladder

• C67.9 – Malignant neoplasm of bladder, unspecified

• Z51.11 – Encounter for antineoplastic chemotherapy (e.g., mitomycin, gemcitabine)
  (List as principal diagnosis)

• Z51.12 – Encounter for antineoplastic immunotherapy (e.g., BCG)
  (List as principal diagnosis)
  

• Z85.51 – Personal history of malignant neoplasm of bladder (use for surveillance when no active disease)

Note: ICD‑10‑CM does not capture grade/stage—keep these in the documentation.

Code to the specific location of the tumor when known. Documentation should reflect bladder cancer stage, grade, and risk category. 

Reimbursement Considerations

• New Drug: Until ASP is available (~2 quarters), reimbursed at 103% of WAC

• Medicare Part B: Paid at 106% of ASP once established

• Documentation Requirements: 

  • Bladder cancer type, stage, risk category, tumor location

  • Amount instilled, amount discarded (modifier -JW)

  • Rationale for choosing Zusduri

• Appeals & Prior Authorization: Often required; expect record requests

• Coverage: Typically follows FDA-approved indications; confirm with payer before administration

Key Takeaways

• Zusduri provides prolonged bladder drug exposure for eligible recurrent, low-grade, intermediate-risk non-muscle invasive bladder cancer patients

• Use CPT 51720 for instillation and J9999 (or payer-specific unlisted code) for the drug

• Detailed documentation is critical for coverage and payment

• Expect WAC-based reimbursement until ASP is established