CommercialBilling CodesHigh impact
11.17.06v, Surgical and Minimally Invasive Treatments for Urinary Outlet Obstruction due to Benign Prostatic Hyperplasia (BPH)
Independence Blue Cross·PA · Urology·Medical Policy
Effective date
Jul 28, 2025
We identified it
Jun 19, 2026
Summary
Independence Blue Cross updated policy 11.17.06v to 11.17.06x, removing age and prostate volume restrictions for Aquablation (water-jet hydrosection) procedures, adding CPT 55801 as medically necessary, and reclassifying prostate artery embolization (PAE) code 37242 as experimental/investigational while removing code 53899.
Action Required
By July 28, 2025: Billing team must update billing software to add CPT 55801 as a covered (medically necessary) code for Aquablation procedures and remove age/volume restrictions from authorization criteria for this procedure. Update claim submission rules to classify CPT 37242 as experimental/investigational requiring prior authorization, and discontinue use of CPT 53899 for prostate artery embolization claims, replacing with 37242. Review any pending Aquablation claims denied for age >80 or prostate volume requirements and resubmit under new criteria. Providers should be notified of simplified approval requirements for Aquablation (removal of age ≤80 and voided volume >125cc requirements). Failure to update billing rules will result in claim denials for CPT 55801 and incorrect payment status for PAE procedures.