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Benign Prostatic Hyperplasia Treatments - Medicare Advantage (Revised)
Act
by Aug 1, 2026
Effective date
Sep 1, 2026
Identified
Aug 28, 2026
Summary
This is a comprehensive Medicare Advantage coverage policy for Benign Prostatic Hyperplasia treatments effective September 1, 2026. The policy outlines coverage determinations for multiple BPH treatment modalities including surgical procedures (TURP, prostatectomy, laser therapies), temporary implanted devices, stents, and diagnostic testing. The policy references multiple MAC-specific Local Coverage Determinations (LCDs) that vary by geographic jurisdiction, requiring billing teams to verify applicable coverage rules based on patient location.
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What to do
by Aug 1, 2026 · 9 steps
01Billing team must complete the following actions.
02Identify all applicable Medicare Administrative Contractor (MAC) jurisdiction rules for your practice's patient locations using the geographic mapping provided in the policy (pages 2-3).
03Review the MAC-specific LCDs for your jurisdiction(s) - particularly for Transurethral Waterjet Ablation (L38682, L38367, L38378, L38705, L38712, L38549, L38726), Fluid Jet System (L38367), Laser Ablation (L34090), Rezum System (A56083), and Urodynamics testing (L33576, L34056, A57455, A56802).
04Update billing system and encounter forms to reflect coverage rules specific to each MAC jurisdiction.
05Establish pre-authorization workflows for BPH procedures that require prior approval under applicable LCDs.
06Train clinical and billing staff on diagnostic testing requirements (post-void residual measurement, urinalysis, cystoscopy, ultrasonography, urodynamic and uroflowmetry testing as clinically indicated).
07Configure billing software to flag claims for procedures performed in states/territories not covered by your primary MAC for manual review.
08Failure to apply correct MAC-specific rules will result in claim denials and payment delays.
09Verify LCD applicability BEFORE service delivery.
Original notice
Benign Prostatic Hyperplasia Treatments - Medicare Advantage (Revised)
mcp.humana.com · Always check the source before changing claims.
Related changes
See all Humana changes →Benign Prostatic Hyperplasia Treatments - Medicare Advantage (Revised)MediumEffective Sep 1, 2026 · Medicare AdvantageBenign Prostatic Hyperplasia Treatments - Medicare Advantage (Revised)HighEffective Aug 3, 2026 · Medicare AdvantageBenign Prostatic Hyperplasia Treatments - Medicare Advantage (Revised)MediumEffective Jun 1, 2026 · Medicare AdvantageBrowse every Humana change in the policy list
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