Benign Prostatic Hyperplasia (BPH) Surgical Treatments - (0159)

Cigna covers established surgical and minimally invasive BPH treatments per AUA (e.g., TURP, TUIP, TUVP, PVP 120/180W, HoLEP/ThuLEP, PUL/UroLift, WVTT/Rezūm, RWT/AquaBeam, and open/laparoscopic/robotic prostatectomy for large glands) and explicitly deems therapies not medically necessary (absolute ethanol injection, HIFU, histotripsy, TIND, transrectal thermal therapy, transurethral balloon dilation, WIT) and certain CPT/HCPCS codes (53865; 53899; 55899; 76999; 0950T; HCPCS C9769). Coverage requires documented BPH diagnosis with objective findings and procedure-specific indications (e.g., moderate–severe LUTS refractory to medical therapy or renal insufficiency, refractory retention, recurrent UTIs/stones, gross hematuria), documentation of prior medical therapy/response, adherence to device eligibility (e.g., prostate size, absence of obstructive median lobe where required), and use of appropriate current procedure/diagnosis codes or claims will be denied.