Traditional MedicareCoverageHigh impact
Fluid Jet System Treatment for LUTS/BPH
Medicare/CMS - LCD·Urology, General Practice, Internal Medicine·Local Coverage Determination
Effective date
Apr 1, 2026
We identified it
Jul 28, 2026
Summary
This is a NEW Local Coverage Determination (LCD L38367) from Wellpoint Federal establishing coverage policy for Fluid Jet System treatment for Lower Urinary Tract Symptoms (LUTS) and Benign Prostatic Hyperplasia (BPH). The policy became effective April 1, 2026, and applies to both Medicare Part A and Part B. Billing teams must immediately review the full policy text to identify specific covered procedures, billing codes, prior authorization requirements, and medical necessity criteria.
Action Required
URGENT - Before April 1, 2026: (1) Billing team and clinical staff must access and thoroughly review the complete policy text at https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=38367&ver=32 to extract specific CPT/HCPCS codes, prior authorization requirements, and medical necessity documentation requirements. (2) Update billing software rules and encounter templates in the EHR to reflect any new prior authorization requirements for Fluid Jet System procedures. (3) Notify all providers (especially urology and primary care) of coverage criteria and required documentation. (4) Brief front desk and authorizations staff on any new workflows. (5) Configure claim scrubbing to enforce policy requirements. Failure to implement may result in claim denials for this new treatment modality. NOTE: The policy content summary provided does not include specific procedure codes or detailed requirements - the full policy document must be reviewed immediately.