LCD Reference Article Response To Comments Article

Response to Comments: Transurethral Waterjet Ablation of the Prostate

A58523

Expand All | Collapse All
Draft Article
Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.

Document Note

Note History

Contractor Information

Article Information

General Information

Source Article ID
N/A
Article ID
A58523
Original ICD-9 Article ID
Not Applicable
Article Title
Response to Comments: Transurethral Waterjet Ablation of the Prostate
Article Type
Response to Comments
Original Effective Date
12/27/2020
Revision Effective Date
N/A
Revision Ending Date
N/A
Retirement Date
N/A

CPT codes, descriptions, and other data only are copyright 2023 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

Current Dental Terminology © 2023 American Dental Association. All rights reserved.

Copyright © 2024, the American Hospital Association, Chicago, Illinois. Reproduced with permission. No portion of the AHA copyrighted materials contained within this publication may be copied without the express written consent of the AHA. AHA copyrighted materials including the UB‐04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution, or derivative work without the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at 312‐893‐6816.

Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions; and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates.

CMS National Coverage Policy

N/A

Article Guidance

Article Text

In addition to the Open Meeting of July 15th, Noridian received eight additional comments from Jurisdictions E and F. The responses below address the three issues emphasized in all of the Comments. In addition, one author added additional observations regarding preserved sexual function in his series of patients. Noridian again wishes to express appreciation to all presenters and Commenters.

Response To Comments

Number Comment Response
1

Multiple commenters recommended removing the upper limit of prostate volume (currently 80 ml) or increase upper limits to at least 150 ml. Based on The 2-year results of the WATER II study (prostates 80 mL to 150 mL) demonstrated comparable outcomes in safety and efficacy to those reported in the WATER study (prostates 30 mL to 80mL). The mean prostate size for the study was 107 ml and 83% of the participants had a large median lobe. Compared to the gold standard for large prostates simple prostatectomy, aquablation offers a shorter average length of stay, decrease rates of incontinence, ejaculation dysfunction, and erectile dysfunction. Aquablation clearly provides a needed surgical benefit for larger prostates. This recommendation is aligned with the FDA label where no prostate size limitation is imposed.

Noridian Healthcare Solutions agrees to amend prostate volume to 30-150 cc after careful review of very recently published literature.

2

Multiple commenters recommended removing post-void residual (PVR) urine volume restrictions, >300 mLs from the limitation section of the LCD. Commenters stated patients with high PVR have obstructive disease that requires surgical treatment. Many of these patients are also catheter dependent pre-procedure and no longer require a catheter post-procedure. Commenters stated that findings suggest that robotically executed removal of prostate tissue may be more effective and consistent especially in more complex and large anatomy therefore improving bladder function. As a result, the PVR exclusion should be removed from the proposed LCD for Aquablation.

Noridian Healthcare Solutions received multiple comments regarding the limitation by post-void residual. After review of the recently published literature, Noridian agrees to remove limitation #8 post void residual urine volume > 300 mL.

3

A comment was submitted supporting the creation of an LCD for aquablation procedure/technology as they believe this will add another valuable tool in the BPH treatment arsenal. However, a few language changes to the proposed LCD were recommended. For limitation # 2:" Known or suspected prostate cancer (based on NCCN Prostate Cancer Early Detection guidelines) or a prostate specific antigen (PSA) > 10 ng/ml," the following amendment was suggested: "Known or suspected prostate cancer (based on NCCN Prostate Cancer Early Detection guidelines unless the patient has had a negative prostate biopsy within the last 6 months". The commenter feels the current limitation will exclude candidates who would otherwise be well suited for this treatment as BPH is a known factor in PSA elevation.

Noridian Healthcare Solutions would expect that each provider evaluates each patient according to NCCN guidelines for prostate cancer detection and performs a workup according to the guidelines. Suggestion to incorporate the verbiage of “unless the patient has had a negative prostate biopsy within the last 6 months” in limitation #2 is accepted.

N/A

Coding Information

Bill Type Codes

Code Description

Please accept the License to see the codes.

N/A

Revenue Codes

Code Description

Please accept the License to see the codes.

N/A

CPT/HCPCS Codes

Please accept the License to see the codes.

N/A

CPT/HCPCS Modifiers

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

ICD-10-PCS Codes

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

Additional ICD-10 Information

Bill Type Codes

Code Description

Please accept the License to see the codes.

N/A

Revenue Codes

Code Description

Please accept the License to see the codes.

N/A

Other Coding Information

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A N/A
N/A
Non-Excluded CPT/HCPCS Ended Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A

Revision History Information

Revision History Date Revision History Number Revision History Explanation
N/A

Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related National Coverage Documents
N/A
SAD Process URL 1
N/A
SAD Process URL 2
N/A
Statutory Requirements URLs
N/A
Rules and Regulations URLs
N/A
CMS Manual Explanations URLs
N/A
Other URLs
N/A
Public Versions
Updated On Effective Dates Status
11/06/2020 12/27/2020 - N/A Currently in Effect You are here

Keywords

N/A