Benign Prostatic Hyperplasia Treatments - Medicare Advantage

This Medicare Advantage policy covers a range of treatments for benign prostatic hyperplasia (BPH) — including Water Vapor Thermal Therapy (Rezum), transurethral and laser procedures (TURP, TUIP, TUMT, TUEVP/TUVP), prostatic urethral lift (PUL), waterjet/Aquablation and other robotic/jet/implantable device therapies, and prostatectomy when medically necessary. Coverage is limited to symptomatic BPH (with procedure-specific age and prostate-volume criteria such as WVTT for patients ≥50 years with prostate 30–80 g and PUL for patients ≥45 years with prostate <100 cc and no obstructive middle lobe), generally requires failure of conservative/nonsurgical management, and is subject to applicable Medicare NCDs/LCDs, MAC jurisdictional rules; therapies with insufficient evidence (e.g., HIFU, some plasma kinetic techniques) may not be covered.

"Information regarding the duration of treatment effect is lacking."