Billing and Coding: Laser Ablation of the Prostate

Coverage for laser ablation of the prostate requires documentation of medical necessity for treatment of benign prostatic hyperplasia (BPH) in the medical record, including duration of BPH and the AUA symptom index, with urodynamics/post-void residual results when performed. Claims must include appropriate ICD-10-CM diagnosis codes, signed documentation, and any required referring physician NPI; providers must follow NCCI/OPPS edits and ABN/modifier rules (GA/GX/GZ/GY) with Part A MAC-specific requirements such as occurrence code 32 when an ABN is used.

"Laser ablation of the prostate is covered when the medical record documents medical necessity for treatment of benign prostatic hyperplasia (BPH) in accordance with LCD L34090."

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