Urology · Payer Center
Go to the source, not to someone's summary
Rates, coverage rules and edits change on their own cycle. This is a curated route to the authoritative sources — plus the operational playbooks for actually working an authorization or an appeal.
16 verified sources2 operational playbooks
We link, we do not republish. This site prints no reimbursement rates, ASP amounts or fee schedule figures. Payment changes quarterly or annually, varies by locality and contract, and a number copied here would be wrong for someone. Every link below goes to the body that publishes the authoritative version, and every URL was checked before publication.
Appeals, enrolment & compliance
The processes you need when a claim is wrong, a provider is new, or an arrangement needs checking.
- Medicare FFS appealsThe five levels, the deadlines at each, and what each requires.cms.gov
- Provider enrolmentMedicare enrolment, revalidation and change reporting.cms.gov
- NPPESNPI application and maintenance.nppes.cms.hhs.gov
- CAQH ProViewThe credentialing profile most commercial payers draw from.proview.caqh.org
- OIG — physician compliance educationSelf-referral and anti-kickback fundamentals, in plain terms, before you structure an ancillary arrangement.oig.hhs.gov
Coding & specialty guidance
Urology-specific interpretation, and the code set itself.
- AUA — Practice Management & CodingSpecialty coding resources, guidance requests and the coding and reimbursement committee.auanet.org
- AUA — Reimbursement advocacyWhere the specialty is engaging on payment policy, and why rates move.auanet.org
- AMA — CPTThe code set and its official guidance.ama-assn.org
- HCPCSLevel II codes, including drugs and supplies, and the quarterly update files.cms.gov
- LUGPA — policy & advocacyIndependent urology group perspective on payment policy and its consequences.lugpa.org
Medicare payment & coverage
The primary sources. Rates and policy change on their own cycle, so use these rather than any figure republished elsewhere — including by us.
- Physician Fee Schedule Look-Up ToolSearch payment amounts by code and locality. This is the authoritative source for Medicare rates.cms.gov
- Physician Fee Schedule — rules & filesAnnual proposed and final rules, including the policy changes that move procedural specialties.cms.gov
- Medicare Coverage CenterNational coverage determinations and the entry point to the coverage database.cms.gov
- Local Coverage DeterminationsHow your MAC decides what is reasonable and necessary in your jurisdiction.cms.gov
- NCCI editsProcedure-to-procedure edits — the rulebook behind most unbundling denials.cms.gov
- Internet-Only ManualsThe claims processing and benefit policy manuals, when you need the underlying instruction.cms.gov
Playbook
Working a denial or underpayment
Rank by dollars, fix by root cause, and treat underpayment as a separate discipline from denial.
- 01Categorise by root cause — registration, authorization, coding, documentation, submission — because those are the categories with owners.
- 02Split hard denials from soft: money lost versus money delayed are different problems.
- 03Rank by dollars as well as by count. In a procedural specialty a single surgical claim can outweigh dozens of small ones.
- 04For underpayment, load your contracted fee schedules. Without them the error class is invisible rather than rare.
- 05Check the applicable LCD or payer policy before appealing on medical necessity — cite the criterion you met.
- 06Watch the appeal deadline at each level; recoverable revenue expires quietly in an unworked queue.
Playbook
Working a prior authorization
The queue that can empty an OR block. Run it as a tracked process with an owner and a clock, not as a task.
- 01Build a one-page requirements sheet per procedure, per payer: required or not, criteria the note must demonstrate, submission channel, expected turnaround. Date it and review quarterly.
- 02Start the clock at order entry, not at first submission — time-to-decision is what the schedule cares about.
- 03Embed the payer's own criteria language in the clinical note template for your highest-volume procedures.
- 04Review everything past target daily, with a defined escalation to peer-to-peer.
- 05Book the case against auth status. Pencil without approval; never confirm to a patient without a decision or a documented risk acceptance.
- 06Track auth-related cancellations and median time-to-decision as standing metrics.
Commercial payer medical policy portals are not listed here. Each practice’s payer set is different, and a generic list would send you to plans you do not contract with. In production this section becomes a filterable directory scoped to your own contracted payers and state.