CommercialCoverageMedium impact
Minimally Invasive Treatments for Benign Prostatic Hyperplasia (BPH) 7.01.104
Excellus BlueCross BlueShield·Urology, Radiology·Urinary System (Genitourinary)
Effective date
Oct 16, 2025
We identified it
Jun 20, 2026
Summary
Excellus BlueCross BlueShield has updated their policy for minimally invasive BPH treatments, effective October 16, 2025. The policy establishes specific medical appropriateness criteria for prostatic urethral lift (UroLift), water vapor therapy (Rezūm), waterjet ablation (Aquabeam), and prostate artery embolization, while classifying other treatments as investigational.
Action Required
Before October 16, 2025: Billing team must update prior authorization requirements for minimally invasive BPH procedures to ensure all documented criteria are met: symptomatic BPH, failed 3-month trial of non-surgical treatments or intolerance, age requirements (45-80 years depending on procedure), prostate volume measurements (30-150cc depending on procedure), and specific contraindication documentation for PAE. Update encounter forms to remind urologists of documentation requirements. Claims may be denied without proper medical appropriateness documentation.