CommercialBilling CodesHigh impact
11.17.06w, Surgical and Minimally Invasive Treatments for Urinary Outlet Obstruction due to Benign Prostatic Hyperplasia (BPH)
Independence Blue Cross·Urology·Medical Policy
Effective date
Jan 1, 2026
We identified it
Jun 19, 2026
Summary
Independence Blue Cross updated policy 11.17.06w to 11.17.06x, effective 01/01/2026, adding new CPT code 52597 (robotic-assisted waterjet resection) as medically necessary, designating CPT 52443 as experimental/investigational, marking CPT 53899 as not medically necessary, and deleting three codes (52647, 0421T, 0619T). Billing teams must update systems to reflect these code status changes immediately upon the effective date.
Action Required
By December 31, 2025: Billing team must update billing software to reflect the following code changes effective 01/01/2026: (1) Add CPT 52597 to medically necessary procedures list and remove prior authorization blocks if any exist; (2) Add CPT 52443 to experimental/investigational status and implement appropriate billing holds or denials; (3) Change CPT 53899 status to not medically necessary and update edits to deny or request prior authorization; (4) Delete CPT 52647, 0421T, and 0619T from all billing system mappings and claim processing rules. Update encounter forms and provider documentation templates to reflect that CPT 52597 (robotic-assisted waterjet resection) is now covered when medical necessity criteria are met. Notify providers and clinical staff of code status changes. Verify that claims submitted on or after 01/01/2026 using deleted codes will be rejected, and resubmit with appropriate current codes. Claims for CPT 52443 submitted without prior approval or experimental/investigational designation will be denied.