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Regence BlueShieldAll Plans · Prior Auth · Prior Authorization · UrologyMedium impact

Devices for Treatment of Benign Prostatic Hyperplasia, Urethral Stricture, and Urethral Stenosis

Effective date
Jan 1, 2027
Identified
Oct 7, 2026

Summary

Effective January 1, 2027, the Optilume Urethral Drug Coated Balloon may be considered medically necessary for recurrent anterior (bulbar) urethral stricture when the stricture is located in the anterior (bulbar) urethra, is 3 cm or less in length, and has failed prior endoscopic treatment such as direct visual internal urethrotomy or dilation. The Optilume Urethral Drug Coated Balloon is investigational when those criteria are not met, including penile urethral stricture, first-time treatment, and repeated use of the device. The temporarily implanted nitinol device (iTind), the Optilume BPH Catheter System, and the prostatic urethral scaffold (Zenflow Spring) are investigational for all indications.

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What to do

Action · 2 steps
01Effective January 1, 2027: Submit the following documentation for review of requests under this policy: history and physical or chart notes, the specific device being requested, documentation of the size and location of the stricture to be treated, and documentation of prior endoscopic treatment.
02If any of these items are not submitted, it could impact the review and decision outcome.

Codes mentioned

5228452443538555386553866

Original notice

Devices for Treatment of Benign Prostatic Hyperplasia, Urethral Stricture, and Urethral Stenosis
beonbrand.getbynder.com · Always check the source before changing claims.
View original ↗

Related policy hubs

Regence BlueShield policiesUrologyCode 52284Code 52443Code 53855Code 53865Code 53866

Summaries are AI-assisted. Always confirm against the original payer notice.

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