Transcription of Prostate Surgeries and Interventions
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Prostate Surgeries and Interventions
Prostate Surgeries and Interventions Page 1 of 21 UnitedHealthcare Commercial Medical Policy Effective 05/01/2022 Proprietary Information of UnitedHealthcare. Copyright 2022 United HealthCare Services, Inc. UnitedHealthcare Commercial Medica l Policy Prostate Surgeries and Interventions Policy Number: 2022T0618C Effective Date: May 1, 2022 Instructions for Use Table of Contents Page Coverage Rationale .. 1 Documentation Requirements .. 2 Applicable Codes .. 3 Description of Services .. 4 Clinical 4 Food and Drug 17 References .. 18 Policy History/Revision Information .. 21 Instructions for 21 Coverage Rationale Transurethral ablation of the Prostate is proven and medically necessary in certain circumstances. For medical necessity clinical coverage criteria, refer to the InterQual 2022, Apr. 2022 Release, CP: Procedures, Prostatectomy, Transurethral Ablation. Click here to view the InterQual criteria.
In this 19-center study, 206 subjects ≥ 50 years old with an International Prostate Symptom Score (IPSS ) > 12, peak flow rate (Qmax) ≤ 12 mL/s, and prostate volume 30 cc -80 cc were randomized 2:1 to the PUL procedure or blinded sham control. IPSS improvement after PUL was 88% greater than that of sham at 3 months.
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