CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Temporarily implanted nitinol device (e.g., iTind) for BPH — Coverage Criteria

Policy governing coverage and medical necessity determinations for temporarily implanted nitinol devices (eg, iTind) to treat lower urinary tract symptoms from benign prostatic hyperplasia for Blue Cross Blue Shield - Rhode Island members.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyTemporarily implanted nitinol device (e.g., iTind) for BPH — Coverage Criteria

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateMay 1, 2023

Next Review DateN/A

Key ActionVerify member-specific benefits and eligibility; prior authorization is not applicable but check subscriber agreements for potential requirements.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Not coveredMedicare Advantage stance

Not medically necessaryCommercial stance

53865New HCPCS code

C9769HCPCS code deletion

2025-02-19Last review

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Coverage and Medical Necessity Determinations

Coverage determination

Covered when ALL of the following are met:

Medicare Advantage stance: Use of a temporarily implanted nitinol device (eg, iTind) for treatment of lower urinary tract symptoms due to benign prostatic hyperplasia is not covered because the evidence is insufficient to determine the effects of the technology on health outcomes.

Commercial Products stance: Use of a temporarily implanted nitinol device (eg, iTind) for treatment of lower urinary tract symptoms due to benign prostatic hyperplasia is considered not medically necessary because the evidence is insufficient to determine the effects of the technology on health outcomes.

Evidence summary: Available evidence includes a network meta-analysis, 1 randomized controlled trial versus sham, and multicenter prospective single-arm studies; results are inconsistent and do not demonstrate clear net health benefit compared with established treatments.

See Background for details on trials, symptom score changes, and comparative evidence gaps.

Benefits for temporarily implanted nitinol devices may vary by group and contract. Providers should refer to the member's applicable Benefit Booklet, Evidence of Coverage, or Subscriber Agreement to determine whether the service is a not medically necessary or non‑covered benefit for that member.

Coverage and medical necessity determinations are governed by the member's subscriber agreement, member certificate, and/or employer participation agreement, which supersede this policy. Confirm member‑specific coverage and eligibility before scheduling services; if a service is non‑covered, the member must be informed and provide written agreement before being charged.

For Commercial Products, the use of a temporarily implanted nitinol device (eg, iTind) to treat lower urinary tract symptoms from benign prostatic hyperplasia is considered not medically necessary because the evidence is insufficient to determine the effect of the technology on health outcomes.

Relevant Billing Codes

Not covered / Not medically necessary HCPCS codesHCPCSNot Covered

53865	Cystourethroscopy with insertion of temporary device for ischemic remodeling (ie, pressure necrosis) of bladder neck and prostate (New Code Effective 1/1/2025)
C9769	Cystourethroscopy; with insertion of temporary prostatic implant/stent with fixation/anchor and incisional struts (Code Deleted Effective 12/31/2024)

Provider Requirements, Prior Authorization, and Billing Guidance

Prior Authorization

Prior authorization

Not applicable

Denial Risk

Denial risk for Medicare Advantage

The use of a temporarily implanted nitinol device (eg, iTind) for treatment of lower urinary tract symptoms due to benign prostatic hyperplasia is not covered for Medicare Advantage members.

Affected codes: temporarily implanted nitinol device (eg, iTind) procedures

Denial Risk

Denial risk for Commercial

The use of a temporarily implanted nitinol device (eg, iTind) is considered not medically necessary for Commercial products; claims are subject to denial as not medically necessary.

Clinical Background

Benign prostatic hyperplasia (BPH) is a common, age‑related enlargement of the prostate that can cause lower urinary tract symptoms (LUTS) including frequency, urgency, nocturia, hesitancy, weak stream, and retention. These symptoms can progress to complications such as urinary tract infections, bladder stones, or renal insufficiency. Temporarily implanted nitinol devices (eg, iTind) are minimally invasive implants placed in the prostatic urethra for approximately 5–7 days to produce ischemic remodeling and urethral tissue reshaping intended to improve urinary outflow.

Definitions and Abbreviations

Temporarily implanted nitinol device (iTind) — key attributes

Device typeTemporarily implanted nitinol device (example: iTind)

Design and mechanismIntertwined nitinol (three double) struts configured to expand and apply circumferential force causing ischemic necrosis and tissue reshaping of the prostatic urethra

Intended effectUrethral expansion and creation of longitudinal channels to improve urine outflow in BPH

Typical implantation durationDevice is typically implanted for approximately 5–7 days then removed

AUASI / IPSS — symptom scoring systems

InstrumentsAUASI (American Urological Association Symptom Index) and IPSS (International Prostate Symptom Score)

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyTemporarily implanted nitinol device (e.g., iTind) for BPH — Coverage Criteria

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateMay 1, 2023

Next Review DateN/A

Key ActionVerify member-specific benefits and eligibility; prior authorization is not applicable but check subscriber agreements for potential requirements.

SourceLink

On This Page

Affected codes: temporarily implanted nitinol device (eg, iTind) procedures

Billing Rule

Benefit verification required

Benefits and coverage may vary by contract. Verify member-specific benefits, eligibility, and any applicable prior authorization requirements in the member's Benefit Booklet, Evidence of Coverage, or Subscriber Agreement prior to scheduling or billing.

Refer to applicable Benefit Booklet, Evidence of Coverage, or Subscriber Agreement
Confirm member eligibility and benefits before providing services

Step Therapy

Therapy sequencing

Recommend that medical therapy be attempted first (alpha‑adrenergic blockers, 5‑alpha‑reductase inhibitors, combination therapy, antimuscarinics, PDE‑5 inhibitors) and that patients who do not respond or who have significant side effects be managed according to standard surgical referral criteria (eg, AUA guidance) before considering device-based interventions.

Medical therapy options: alpha‑blockers, 5‑ARIs, combination therapy, antimuscarinics, tadalafil
Refer to AUA criteria for surgical referral (eg, renal insufficiency due to BPH, refractory urinary retention, recurrent UTIs, bladder stones, gross hematuria, LUTS refractory to other therapies)

Billing Rule

Member eligibility and billing

Services are determined by the member's subscriber agreement, member certificate, and/or employer agreement. For services that are non‑covered benefits in some cases (including medically necessary services that are non‑covered under the member's plan), providers must obtain the member's written agreement before billing the member for such services.

Member financial responsibility rules: obtain written agreement prior to providing non‑covered services at member's expense
Participation agreement provisions may apply

Note

Verify coverage and authorization

This policy is informational and not a guarantee of payment. BCBSRI may review and revise the policy at any time. For member‑specific coverage determinations, follow the subscriber agreement/certificate or employer agreement; those documents supersede this policy.

Do not rely on this policy alone for payment guarantees
Contact BCBSRI for policy updates or questions

PurposeSelf‑administered questionnaires to quantify severity of lower urinary tract symptoms due to BPH

Scoring rangeTotal scores range from 0 to 35

Severity categoriesMild <7; Moderate 8–19; Severe 20–35

Additional componentIPSS includes a quality-of-life ‘bother’ question derived from the AUASI

TIND / TINd — abbreviation and description

AbbreviationsTIND or TINd (temporary implantable nitinol device)

DescriptionA minimally invasive temporary implant placed in the prostatic urethra composed of nitinol struts that expand to relieve obstruction-related lower urinary tract symptoms

MechanismApplies circumferential pressure producing ischemic remodeling/necrosis of mucosa, resulting in urethral expansion

Removal and retrievalTypically removed after 5–7 days; a distal retrieval wire permits snare or cystoscopic removal into a sheath or catheter