Does 0421T require prior authorization?

No, 0421T does not require prior authorization (high confidence). Code is covered without prior authorization.

`0421T` — Waterjet destruction of prostrate accessed through the urethra

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

When required, the name and NPI of the referring/ordering physician must be reported on the claim.
The claim must include a valid ICD-10-CM diagnosis code that best describes the patient's condition for which the service was performed.
Providers should verify and comply with applicable NCCI and OPPS requirements prior to billing Medicare for these procedures.
Maintain all documentation in the patient's medical record and make it available to the contractor upon request.

Transurethral waterjet ablation of the prostate is covered only when it is reasonable and necessary and the patient meets the clinical criteria specified in Local Coverage Determination (LCD) L38712.
Transurethral waterjet ablation of the prostate is covered only when it meets the reasonable and necessary requirements specified in Local Coverage Determination L38726.
Fluid Jet System Treatment for Lower Urinary Tract Symptoms (LUTS) due to Benign Prostatic Hyperplasia (BPH) is the covered service addressed by this coding article and should be billed in accordance with the applicable LCD for the procedure.
Coverage of the fluid jet system for treatment of benign prostatic hyperplasia (BPH) is subject to the reasonable and necessary clinical criteria specified in Local Coverage Determination L38378; billing must meet those LCD criteria.
Transurethral waterjet ablation of the prostate is covered only when the service meets the reasonable and necessary requirements specified in Local Coverage Determination (LCD) DL38705.
Coverage for transurethral waterjet ablation of the prostate is determined by Local Coverage Determination (LCD) DL38707 and is allowed only when the LCD's reasonable and necessary requirements are met.

L40194 — Transurethral Waterjet Ablation of the Prostate

J05

L35490 — Category III Codes

J05

L38682 — Transurethral Waterjet Ablation of the Prostate

J05

A58209 — Billing and Coding: Transurethral Waterjet Ablation of the Prostate

J05

L38367

Ask Verity about documentation requirements, denial risks, or coverage in your state.