Summary
Use of prostatic urethral lift in individuals with moderate-to-severe lower urinary tract obstruction due to benign prostatic hyperplasia may be considered medically necessary when all of the listed criteria are met. Use of prostatic urethral lift in other situations, including repeat procedures, is considered investigational.
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What to do
Action · 7 steps
01Billing team: Before billing CPT 52441 or 52442, or HCPCS C9739 or C9740, document that all of the criteria are met.
02The criteria are persistent or progressive lower urinary tract symptoms despite medical therapy (alpha-1 adrenergic antagonists maximally titrated, 5-alpha reductase inhibitors, or combination medication therapy maximally titrated) over a trial period of no less than 6 months, or inability to tolerate medical therapy; prostate gland volume of 80 mL or less; normal bladder neck without an obstructive or protruding median lobe; no acute urinary retention related to conditions other than benign prostatic hyperplasia, urinary tract infection, or recent prostatitis within the past year; appropriate testing to exclude prostate cancer; and no known allergy to nickel, titanium, or stainless steel.
03These codes are listed as medically necessary only when the procedure is performed according to the Policy section.
04BCBSMS makes no payment for services not documented to be medically necessary.
05Repeat procedures are considered investigational.
06Check the member's specific benefit plan language, because the coverage guidelines should not be used in lieu of it.
07For Federal Employee Program members, FDA-approved devices, drugs or biologics may not be considered investigational and may be assessed only on the basis of medical necessity.
Codes mentioned
5244152442C9739C9740N40.1N40.3
Original notice
Prostatic Urethral Lift
bcbsms.com · Always check the source before changing claims.