Transurethral Waterjet Ablation of the Prostate

Transurethral waterjet ablation is covered once per lifetime for patients with LUTS due to BPH who meet all criteria: prostate volume 30–150 mL, IPSS ≥12, Qmax ≤15 mL/s, and failure/contraindication/intolerance to at least 3 months of conventional medical therapy; the procedure must use an FDA-approved/cleared device. Coverage is excluded for multiple conditions including BMI ≥42 kg/m2, known or suspected prostate cancer (or PSA >10 ng/mL without a negative biopsy within 6 months), bladder pathology, active infection, urethral or sphincter structural problems, chronic prostatitis, allergy to device materials, or inability to safely stop anticoagulants/antiplatelets.

"Transurethral waterjet ablation of the prostate is reasonable and necessary for treatment of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) when prostate volume is 30..."