Geographic Access to Urodynamics Studies in the United States: A Medicare-Based Geospatial Analysis

Objectives: This study aimed to evaluate geographic access to traditional versus video urodynamics testing in the United States and Puerto Rico utilizing Medicare-billing data. Methods: We performed a national geospatial analysis using the 2024 Medicare Physician and Other Practitioners Public Use File. Clinicians in urology and obstetrics and gynecology who billed Medicare Part B for urodynamics testing were identified using prespecified Healthcare Common Procedure Coding System (HCPCS) codes. Billing addresses from the mainland U.S. and Puerto Rico were cleaned, deduplicated, geocoded, and classified as centers offering traditional or video-associated urodynamics testing. State-level center density was calculated per million women using 2019-2023 American Community Survey population estimates. Centers were classified as metropolitan or nonmetropolitan using 2021 Census core-based statistical area boundaries. Census tract centroids were used as population origins, and distance to the nearest testing center was calculated and female population-weighted nationally and by state. Results: Approximately 26.2 million women (15.7%) lived more than 100 miles from a video-associated urodynamics testing center, and 800,000 women (0.5%) lived more than 100 miles from a traditional urodynamics testing center. We identified 165 centers billing for video-associated urodynamics testing and 2,397 centers billing for traditional urodynamics testing in the United States and Puerto Rico. Testing centers were concentrated in the Northeast and Florida, with fewer centers across the Great Plains and Mountain West. Among 392 metropolitan areas, 310 (79%) lacked a video-associated urodynamics testing center, and 70 (17.9%) lacked a traditional urodynamics testing center. National median population-weighted distance was 27.8 miles for video-associated urodynamics testing and 3.6 miles for traditional urodynamics testing. The greatest access gaps differed by testing type but generally were observed in rural or low-density states. Conclusions: Most women in the United States live within a short distance of a center billing for urodynamics testing, but meaningful geographic access gaps remain, particularly in rural regions, the Great Plains, and the Mountain West. These findings highlight the need for regional referral pathways, outreach models, and improved triage systems for patients with complex lower urinary tract symptoms (LUTS) who may require urodynamics evaluation.