Prostatic Urethral Lift

This policy covers prostatic urethral lift (PUL) as a minimally invasive procedure to treat moderate-to-severe lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH). Coverage is limited to men with persistent or progressive LUTS despite a trial of maximally tolerated medical therapy for at least 6 months (or documented inability to tolerate medical therapy), with prostate gland volume ≤80 mL, no active urinary tract infection, and no prostatitis within the past year. PUL is considered experimental/investigational if criteria are not met, is not indicated for non‑BPH causes or women, is contraindicated in prostates >100 cc, and the evidence is limited with uncertain comparative effectiveness versus TURP.

"Moderate-to-severe lower urinary tract obstruction due to benign prostatic hyperplasia (BPH)."

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