CommercialCoverageMedium impact
Focal Therapies for Prostate Cancer Treatment 7.01.01
Excellus BlueCross BlueShield·Urology, Oncology·Urinary System (Genitourinary)
Effective date
Aug 21, 2025
We identified it
Jun 20, 2026
Summary
Excellus BlueCross BlueShield updated their policy on focal therapies for prostate cancer, effective August 21, 2025. Cryosurgery and HIFU are considered medically appropriate only for recurrent prostate cancer after radiation therapy with no metastases, while all focal therapies for primary prostate cancer treatment remain investigational and non-covered.
Action Required
Before August 21, 2025: Billing team must update prior authorization requirements for prostate cancer focal therapies. Ensure cryosurgery and HIFU claims for Excellus members include documentation of recurrence after radiation therapy with positive repeat biopsy and absence of metastatic disease. Flag all primary focal therapy treatments (VTP, IRE, NanoKnife, LITT, TULSA, magnetic field induction, water vapor thermotherapy) as investigational and non-covered for routine primary treatment.