CommercialAdministrativeLow impact
11.11.03d, Cryosurgical Ablation of the Prostate Gland
Independence Blue Cross·Urology, Oncology, Radiation Oncology·Medical Policy
Effective date
Jan 21, 2026
We identified it
Jun 19, 2026
Summary
Independence Blue Cross reissued Policy 11.11.03d on cryosurgical ablation of the prostate gland, effective 01/21/2026. This is a routine reissue communicating the Company's continuing position with no substantive coverage changes. The policy maintains coverage for CPT 55873 as medically necessary for primary treatment of localized prostate cancer (T1-T3) and salvage therapy under specified criteria, while subtotal prostate cryoablation remains experimental/investigational and non-covered.
Action Required
No immediate action required. Billing team should note the effective date of 01/21/2026 for reference. Continue current billing practices for CPT 55873 under existing coverage criteria (primary treatment for T1-T3 prostate cancer and salvage therapy meeting specified stage, Gleason score, and PSA requirements). No changes to medical necessity documentation, billing codes, or prior authorization processes are indicated. File this reissue for compliance records.