Transurethral Waterjet Ablation of the Prostate

Transurethral waterjet ablation of the prostate is covered when performed with an FDA-approved device for patients with BPH who meet all inclusion criteria: prostate volume 30–150 mL, IPSS ≥12, Qmax ≤15 mL/s, and failure/contraindication/intolerance to ≥3 months of conventional medical therapy. Coverage excludes patients with significant comorbid urologic conditions (e.g., prostate cancer without recent negative biopsy if PSA >10, bladder cancer, neurogenic bladder), certain anatomic or infectious contraindications, BMI ≥42 kg/m², known device allergies, or inability to safely stop anticoagulants; the procedure must be performed by appropriately trained, credentialed providers and is authorized only one time per patient.

"Transurethral waterjet ablation is covered when performed using an FDA-approved or FDA-cleared device."

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