Transurethral Waterjet Ablation of the Prostate

Transurethral waterjet ablation of the prostate is covered as a one-time treatment for men with LUTS/BPH when all criteria are met: prostate volume 30–150 cc by TRUS, IPSS ≥12, Qmax ≤15 mL/s with voided volume >125 mL, and documented failure/contraindication/intolerance to at least three months of conventional medical therapy. Coverage requires use of an FDA-approved device, appropriate provider credentialing, and absence of specific exclusions such as BMI ≥42, suspected/known prostate cancer without recent negative biopsy, active infection, certain bladder/urethral conditions, anticoagulation that cannot be stopped, or allergy to device materials.

"Prostate volume 30–150 cc measured by transrectal ultrasound (TRUS)."

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