Back to dashboard
CommercialCoverageMedium impact

Benign Prostatic Hyperplasia (CPB 0079, reviewed 2026-10-15)

Aetna·Urology·Medical Policy
Effective date
Not stated
We identified it
Oct 23, 2026
Days to comply
—

Summary

Aetna's Clinical Policy Bulletin 0079 on Benign Prostatic Hyperplasia (CPB 0079) was reviewed on 2026-10-15 and establishes medical necessity criteria for BPH treatments, including covered procedures (alpha-blockers, laser therapies, UroLift, tadalafil, etc.) and experimental/investigational approaches that are not covered. The policy specifies coverage limitations for certain devices (UroLume age/prostate size requirements; iTind for specific prostate volumes) and outlines applicable billing codes. This is a policy review document, not a change announcement with a new effective date.

Action Required

Action needed
Billing team should verify whether the practice's current BPH billing procedures and prior authorization workflows align with Aetna's covered procedures (CPT codes 52282, 52441, 52442, 52443, 52450, 52597, 52601, 52648, 52649, 53850, 53854, 53855, 53865, 53866, 37243, and 52281) and confirm that experimental/investigational procedures (including CPT codes 0655T, 0714T, 0867T, 0950T, 37242, 37244, 55873, and 75894) are not being billed for BPH indications without proper denial handling. Confirm current applicability with Aetna, as the 2026-10-15 review date does not establish a change effective date. Ensure UroLume and iTind coding reflects the policy's coverage limitations (age, prostate size, and indication restrictions). Check benefit plan descriptions for plan-specific exclusions, particularly for tadalafil coverage.

Affected Billing Codes

37243
52282
52441
52442
52443
52450
52597
52601
52648
52649
53850
53854
53855
53865
53866
37242
37244
55873
75894
52281