Prostatectomy - Medicare Advantage

This policy covers surgical prostatectomy procedures—including open perineal and retropubic radical prostatectomy, limited or bilateral pelvic lymphadenectomy, and laparoscopic/robotic-assisted radical prostatectomy (eg, CPTs 55810, 55812, 55815, 55840, 55842, 55845, 55866)—for treatment of localized prostate conditions such as T1–T3 prostate cancer, obstructive benign prostatic hyperplasia, and salvage prostatectomy for local recurrence after failure of EBRT, brachytherapy, or cryotherapy. Coverage is limited to services deemed medically reasonable and necessary under Medicare (for example, life expectancy ≥10 years, no distant metastases or regional lymph node involvement), is confined to the listed CPT procedures, and excludes prostatectomy when metastases or nodal disease are present; procedural risks are noted.

"Radical perineal prostatectomy with lymph node biopsy(s) (limited pelvic lymphadenectomy) — CPT 55812"