Summary & Overview
CPT 0867T: Transperineal Laser Ablation of Benign Prostatic Tissue
CPT code 0867T defines a minimally invasive, image-guided laser ablation procedure targeting benign prostatic tissue through a transperineal approach for prostates with volume of 50 mL or more. As a distinct procedural code, it standardizes reporting for this specific technique, which matters nationally as minimally invasive prostate therapies expand and payers evaluate coverage and coding consistency. The code bundles imaging guidance within the service description, affecting billing and utilization tracking.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, typical sites of service, and payer relevance. The publication outlines benchmarks and policy-relevant considerations for coverage and coding, summarizes common modifiers used with this service, and situates the procedure among other prostate-targeted interventions. It also highlights where input data was not provided by the source.
This report is intended for national audiences including coding professionals, revenue cycle managers, and policy analysts seeking a clear reference on procedural scope, billing implications, and the role of imaging in this CPT-coded service.
Billing Code Overview
CPT code 0867T describes a laser ablation of benign prostatic tissue for an enlarged prostate performed via a transperineal approach (through the tissue between the scrotum and anus). The code includes imaging guidance and applies when the prostate volume is 50 mL or more.
Service Type: Surgical, minimally invasive prostatic tissue ablation with imaging guidance
Typical Site of Service: Ambulatory surgical center or hospital outpatient setting, depending on facility capabilities and clinical needs. If facility designation is not specified, Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 72-year-old man with progressive lower urinary tract symptoms (nocturia, weak stream, incomplete emptying) refractory to medical therapy presents for transperineal laser ablation of benign prostatic hyperplasia. Pre-procedure evaluation includes prostate volume measurement by transrectal ultrasound demonstrating a prostate volume ≥50 mL, urinalysis, assessment of anticoagulation status, and counseling on risks/benefits. On the day of service the patient undergoes conscious sedation or general anesthesia in an ambulatory surgery center or hospital operating room. Under ultrasound and fluoroscopic imaging guidance, the urologist or interventional urologist advances the laser applicator through the perineum into the enlarged transition zone and delivers energy to ablate benign prostatic tissue. Post-procedure care includes short observation, urinary catheter management as indicated, and follow-up to assess symptom relief and monitor for hematuria, urinary retention, infection, or incontinence.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work required is substantially greater than usual for this code due to complexity or intraoperative findings. |
23 | Unusual anesthesia | Use when general anesthesia is medically necessary for an otherwise normally not-anesthetized procedure. |
51 | Multiple procedures | Use when this service is billed with other distinct procedures during the same operative session. |
52 | Reduced services | Use when the procedure is partially reduced or not completed as planned. |
53 | Discontinued procedure | Use when the procedure is started but terminated due to extenuating circumstances. |
62 | Two surgeons | Use when two surgeons work together as primary surgeons for portions requiring dual expertise. |
66 | Surgical team | Use when a surgical team (multiple qualified surgeons) performs the procedure. |
78 | Unplanned return to OR | Use when an unplanned return to the operating room for a related procedure occurs within the global period. |
79 | Unrelated procedure or service by the same physician during the postoperative period | Use when an unrelated procedure is performed during the global period. |
AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | Use when an accredited assistant at surgery participates and meets payer requirements. |
QK | Medical direction of two, three, or four concurrent anesthesia procedures | Use when the physician medically directs multiple concurrent anesthesia services for this case. |
QX | CRNA service with medical direction by a physician | Use when a CRNA furnishes anesthesia with physician medical direction. |
QY | Medical direction of one CRNA by an anesthesiologist | Use when the anesthesiologist directs one CRNA for this procedure. |
TG | Services rendered under the general supervision of a teaching physician: primary surgeon not present | Use in teaching hospitals when the teaching physician meets documentation and supervision rules. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 2080P0800X | Urology | Primary specialty performing transperineal prostate procedures. |
| 2080S0120X | Interventional Urology | Subspecialists performing image-guided prostate ablation. |
| 207L00000X | Family Medicine | May perform pre- and post-procedure evaluation in some settings. |
| 363LA2200X | Anesthesiology | Provides general or monitored anesthesia care for the procedure. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
N40.0 | Enlarged prostate with lower urinary tract symptoms | Primary indication for prostatic ablation when prostate volume ≥50 mL. |
N40.1 | Benign prostatic hyperplasia with lower urinary tract symptoms, without urinary retention | Common reason for intervention when medical therapy fails. |
N13.8 | Other obstructive and reflux uropathy | May coexist when obstruction affects upper tracts; evaluation recommended. |
R33.9 | Retention of urine, unspecified | May be an indication for procedural intervention if chronic or recurrent. |
N39.0 | Urinary tract infection, site not specified | Peri-procedural infection risk to consider in management and coding. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
52000 | Cystourethroscopy, with or without catheterization; diagnostic | Performed preoperatively or intraoperatively to evaluate urethra/bladder or catheter placement. |
51701 | Insertion of temporary indwelling catheter; simple (e.g., Foley) | Often used post-procedure for urinary drainage and to manage hematuria or retention. |
76942 | Ultrasonic guidance for needle placement (e.g., biopsy, aspiration, injection), imaging supervision and interpretation | Used for ultrasound guidance during transperineal needle/applicator placement. |
77002 | Fluoroscopic guidance for needle placement (single plane) | Used when fluoroscopic imaging guidance is employed for applicator positioning. |
99144 | Moderate sedation services provided by the same physician performing the diagnostic or therapeutic service | Used when the surgeon provides moderate sedation during the procedure (if payer allows). |