C2596, Probe, image-guided, robotic, waterjet ablation
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- 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.
- Every page of the record must be legible and include appropriate patient identification information (e.g., full name, dates of service).
- The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care.
Key Coverage Criteria
- Coverage for the Fluid Jet System to treat benign prostatic hyperplasia (BPH) is governed by Local Coverage Determination L38378 and requires meeting that LCD's reasonable and necessary criteria.
- Transurethral waterjet ablation of the prostate is covered only when it meets the reasonable and necessary requirements specified in Local Coverage Determination L38549.
- Transurethral waterjet ablation of the prostate is covered only when the service meets the reasonable and necessary requirements specified in LCD L38705.
- 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.
- Transurethral waterjet ablation (Aquablation) may be considered medically necessary for BPH when: moderate to severe BPH; prostate volume 30cc to 150cc; and prior conservative medical therapy has been unsuccessful, contraindicated, or not tolerated.
19 Active Policies
CGS-L38378, Fluid Jet System in the Treatment of Benign Prostatic Hyperplasia (BPH)
J15
A58209, Billing and Coding: Transurethral Waterjet Ablation of the Prostate
J5
A56797, Billing and Coding: Fluid Jet System Treatment for LUTs/BPH
J6
WPS-L38682, Transurethral Waterjet Ablation of the Prostate
J8
WPS-L35490, Category III Codes
J8
WPS-L40194, Transurethral Waterjet Ablation of the Prostate
J8
A58264, Billing and Coding: Transurethral Waterjet Ablation of the Prostate
J9
FIRST_COAST-L38726, Transurethral Waterjet Ablation of the Prostate
J9
NORIDIAN-L38705, Transurethral Waterjet Ablation of the Prostate
JF
NOVITAS-L38712, Transurethral Waterjet Ablation of the Prostate
JH
PALMETTO-JJ-L38549, Transurethral Waterjet Ablation of the Prostate
JJ
NGS-L38367, Fluid Jet System Treatment for LUTS/BPH
JK
NGS-L40177, Fluid Jet System Treatment for LUTS/BPH
JK
A58243, Billing and Coding: Transurethral Waterjet Ablation of the Prostate
JL
PALMETTO-JM-L38549, Transurethral WaterjetAblation of the Prostate
JM
A58008, Billing and Coding: Transurethral Waterjet Ablation of the Prostate
REGENCE-SUR210, Benign Prostatic Hyperplasia Surgical Treatments
A58227, Billing and Coding: Transurethral Waterjet Ablation of the Prostate
A57926, Billing and Coding: Fluid Jet System in the Treatment of Benign Prostatic Hyperplasia (BPH)
Related Codes
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