Does 52450 require prior authorization?

No, 52450 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 52450?

Medicare facility rate: $437.89. Non-facility rate: $437.89. Work RVU: 7.59.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

7.59

Facility

$437.89

Non-Facility

$437.89

Laboratory values as applicable (e.g., PSA measurements reported in many trials and used as a secondary outcome).
Imaging/angiographic documentation for PAE (prostatic arterial anatomy identification) and documentation of technical feasibility or reasons for technical failure.
Erectile and ejaculatory function assessment (IIEF-5 or IIEF-15, MSHQ, MSHQ-EjD, SHIM) where preservation of sexual function is a treatment goal.
Adverse event reporting classified by Clavien-Dindo grading (many studies used this to grade complications).

ICD-10 codes covered if selection criteria are met: N35.010 - N35.92 Urethral stricture
PAE can be considered in patients with hematuria of prostatic origin as a method of achieving cessation of bleeding. (Level of Evidence: D; strength of recommendation: strong)
Alpha adrenergic blockers (alfuzosin, doxazosin, silodosin, tamsulosin, and terazosin)
Aquablation (AquaBeam, water jet hydrodissection)
Hormonal manipulation (including finasteride, dutasteride, and dutasteride plus tamsulosin)
Interstitial laser coagulation of the prostate (ILCP)

AETNA-CPB-0079 — Benign Prostatic Hyperplasia

HUMANA-BENIGN-PROSTATIC-HYPERPLASIA-TREATMENTS-MA — Benign Prostatic Hyperplasia Treatments - Medicare Advantage

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