Prostate Surgeries and Interventions – Commercial and Individual Exchange Medical Policyopen_in_new

UnitedHealthcare considers cryoablation for biopsy‑proven recurrent prostate cancer, transurethral ablation (including Aquablation/water‑jet for LUTS from BPH), prostatic urethral lift (PUL) per FDA labeling for men ≥45 (excluding prostate volume >100 cc, UTI, urethral insertion barriers, sphincter‑incompetent incontinence, or current gross hematuria), high‑energy water‑vapor thermotherapy in specified circumstances, and prostate artery embolization (PAE) for patients ineligible for other procedures or with persistent prostatic gross hematuria to be medically necessary, while numerous other interventions (eg, TULSA, transperineal focal laser ablation, temporary prostatic stents, TPLA, drug‑coated balloon dilation, and treatments for malignant prostate tissue) are listed as unproven/not medically necessary. Coverage is contingent on meeting specific clinical criteria (often per InterQual®) and documentation requirements (eg, biopsy for cryo, prostate volume and absence of exclusions for PUL, proof of surgical/anesthesia ineligibility for PAE) and remains subject to member‑specific benefit plan terms and applicable laws.