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Excellus BlueCross BlueShieldCommercial · Coverage · Urinary System (Genitourinary) · NY · Urology, RadiologyMedium impact

Minimally Invasive Treatments for Benign Prostatic Hyperplasia (BPH) 7.01.104

Effective date
Oct 16, 2025
Identified
Jun 20, 2026

Summary

Excellus BlueCross BlueShield policy 7.01.104 covers minimally invasive BPH treatments, including prostatic urethral lift, water vapor thermal therapy, Aquablation and prostate artery embolization, when symptomatic BPH is present and device-specific criteria are met, and it lists prostate artery embolization as changed from investigational to medically appropriate for specific indications in its October 16, 2025 update. Transperineal laser ablation, the temporary implantable nitinol device (iTIND) and drug-coated balloons such as Optilume are considered investigational. The policy history also records an 08/04/26 policy edit that updated the professional guidelines section to reflect the 2026 AUA update and changed the prostate artery embolization grade from C to B.

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What to do

Action · 8 steps
01Already effective October 16, 2025: Minimally invasive BPH treatment is medically appropriate only when ALL of these are met: the patient has symptomatic BPH, the treatment is an alternative to TURP, and either non-surgical methods (alpha blocker, PDE5 inhibitor, or finasteride/dutasteride) were tried for at least three months or the patient is unable to tolerate non-surgical treatments, plus the device-specific criteria.
02For prostatic urethral lift (PUL, UroLift), prostate volume must be 30-80cc and none of these may be present: an obstructive middle lobe verified by cystoscopy, urethral conditions that may prevent insertion of the delivery system, signs and symptoms of a urinary tract infection, urinary incontinence due to an incompetent sphincter, or current gross hematuria.
03For water vapor thermal therapy (Rezum), the patient must be 50 years of age or older and prostate volume must be 30-80cc.
04For waterjet ablation (Aquablation), the patient must be 45-80 years old and prostate volume must be 30-150cc.
05For prostate artery embolization (PAE), a contraindication to general anesthesia must be well documented or there must be gross hematuria from the prostate, and the procedure must be performed by an interventional radiologist trained in this procedure.
06Clinical data support an average of four to five PUL implants per procedure.
07HCPCS C9739 describes insertion of one to three transprostatic implants and C9740 describes four or more.
08Codes may not be covered under all circumstances, and the code list may not be all inclusive.

Codes mentioned

37242372435228452441524425244353854538655386652597C2596C9739C9740N40.1

Original notice

Minimally Invasive Treatments for Benign Prostatic Hyperplasia (BPH) 7.01.104
excellusbcbs.com · Always check the source before changing claims.
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Related policy hubs

Excellus BlueCross BlueShield policiesNY policy changesUrologyRadiologyCode 37242Code 37243Code 52284Code 52441Code 52442Code 52443Code 53854Code 53865Code 53866Code 52597Code C2596Code C9739Code C9740Code N40.1

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