Fluid Jet System Treatment for LUTS/BPH

Fluid jet system treatment for LUTS/BPH is covered once for patients with prostate volume 30–150 cc who have persistent moderate to severe symptoms (IPSS ≥ 12) and Qmax ≤ 15 mL/s after at least three months of conventional medical therapy. Coverage requires use of an FDA-approved/cleared device and documentation of IPSS, Qmax, prostate volume, prior medical therapy, and PSA (with negative biopsy within 6 months if PSA >10); multiple clinical conditions (e.g., BMI ≥ 42, active infection, prostate or bladder cancer, neurogenic bladder, urethral strictures, damaged external sphincter, inability to stop anticoagulants) are exclusions.

"Patient has prostate volume between 30 and 150 cc."

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