52630
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
6.39
Facility
$376.09
Non-Facility
$376.09
Documentation Required
- No explicit documentation requirements are provided in the provided excerpt.
- The document references sections such as 'Coding Information' and 'Related CMS Documents Coverage Determination Summary of Evidence References', but no specific required medical records, test results, or clinical documentation are included in this excerpt.
- No specific documentation requirements are stated in this document chunk.
- Documentation of lower urinary tract symptoms (eg, frequency, hesitancy, nocturia, urgency, weak urine stream) in the medical record.
Key Coverage Criteria
- Use of urethral laser approaches to destroy and shrink prostate tissue, including Visually guided laser ablation of the prostate (VLAP).
- Fluid Jet System in the Treatment of Benign Prostatic Hyperplasia
- Rezum System for Benign Prostatic (billing and coding reference - truncated in source)
- Transurethral Waterjet Ablation of the Prostate
- Inferred: Treatment of benign prostatic hyperplasia (BPH) / lower urinary tract symptoms due to BPH (procedures above are presented in context of BPH treatment)
- Benign Prostatic Hyperplasia treatments (inferred from document title only; no explicit covered indications, diagnoses, or clinical scenarios are listed on the provided page)
1 Active Policy
HUMANA-BENIGN-PROSTATIC-HYPERPLASIA-TREATMENTS-MA — Benign Prostatic Hyperplasia Treatments - Medicare Advantage
Related Codes
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