Medicare AdvantageAdministrativeLow impact
MA11.022a, Cryosurgical Ablation of the Prostate Gland
Independence Blue Cross·NJ · Urology, Oncology, Radiation Oncology·Medical Policy
Effective date
Jan 21, 2026
We identified it
Jun 19, 2026
Summary
Independence Blue Cross Medicare Advantage policy MA11.022a on cryosurgical ablation of the prostate gland has been reissued effective 01/21/2026 with no substantive coverage changes. The policy continues to cover complete prostate cryoablation as primary treatment for localized prostate cancer (stages T1-T3) and as salvage therapy for recurrent disease meeting specific criteria, while excluding subtotal cryoablation as experimental/investigational. Billing teams should verify current policy documentation requirements and ensure prior authorization processes align with the effective date.
Action Required
By January 21, 2026: Billing team should verify that claim submissions for CPT 55873 (cryosurgical ablation of the prostate) include appropriate ICD-10 diagnosis code C61 (malignant neoplasm of prostate) and supporting documentation of medical necessity per policy requirements. Confirm that billing system reflects this policy as the active version for Independence Blue Cross Medicare Advantage plans. Ensure prior authorization processes (if required by the plan) are in place before the effective date. Do NOT bill CPT 55873 for subtotal cryoablation procedures, as this remains experimental/investigational and non-covered.