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. The policy maintains coverage for primary treatment of localized prostate cancer (stages T1–T3) and salvage therapy for recurrent disease meeting specific criteria. No substantive coverage changes were made; this is a routine annual reissue to reaffirm the Company's continuing position.
Action Required
By January 21, 2026: Billing team should verify that CPT 55873 (Cryosurgical ablation of the prostate) continues to be billed with ICD-10 diagnosis code C61 (Malignant neoplasm of prostate) and that claims include supporting documentation demonstrating medical necessity (cancer stage T1–T3 for primary treatment, or recurrent disease with prior failed radiation therapy plus stage T2B or below, Gleason score <9, or PSA <8 ng/mL for salvage therapy). Confirm that transrectal ultrasonic guidance is NOT billed separately, as it is included in the cryosurgical ablation procedure. No claim processing workflow changes are required, as coverage criteria remain unchanged from the previous version.