CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Coverage policy for temporary (removable) prostatic urethral stents

Coverage policy for temporary (removable) prostatic urethral stents, governing medical necessity determinations for Blue Cross & Blue Shield of Rhode Island members including distinctions between Medicare Advantage and Commercial products.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyTemporary prostatic stents coverage (temporary removable prostatic urethral stents)

Policy CodePolicy N/A

Change TypeNo material changes

Effective Date05 | 04 2010

Next Review DateN/A

Key ActionVerify member benefits and financial responsibility per the member's benefit booklet/Evidence of Coverage before providing temporary prostatic stent services.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

53855Covered CPT code

up to 30 daysFDA-approved duration

CoveredMedicare Advantage stance

Not coveredCommercial stance

Coverage Criteria for Temporary Prostatic Urethral Stents

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyTemporary prostatic stents coverage (temporary removable prostatic urethral stents)

Policy CodePolicy N/A

Change TypeNo material changes

Effective Date05 | 04 2010

Next Review DateN/A

Key ActionVerify member benefits and financial responsibility per the member's benefit booklet/Evidence of Coverage before providing temporary prostatic stent services.

SourceLink

On This Page

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.

Provider Actions and Administrative Requirements

Prior Authorization

Prior Authorization Required

Prior authorization is not required for temporary prostatic stents under this policy. Verify member benefits and any prior authorization rules that may apply to the member's specific contract or group.

Prior authorization: Not applicable under this policy — verify benefits per member's contract
Benefit verification: Check the member's Evidence of Coverage/Subscriber Agreement for coverage details and any applicable administrative requirements

Denial Risk

Commercial Denial Risk

Commercial products: Temporary prostatic stents are considered not medically necessary for Commercial products and may be denied. Providers should confirm coverage and medical necessity requirements with the member's plan before proceeding.

Commercial denial risk: May be denied as not medically necessary for Commercial products
Provider action: Inform member and obtain written agreement if proceeding with non-covered services per participation agreement

Note

Benefit Verification

Verify benefits and eligibility through the member's Evidence of Coverage/Subscriber Agreement or employer agreement. These documents govern coverage and supersede this medical policy. For member-specific questions, contact the provider call center.

Benefit verification: Check Evidence of Coverage/Subscriber Agreement for member-specific coverage
Contact provider call center for eligibility and benefit questions

Background

Prostatic obstruction can arise from multiple etiologies including benign prostatic hyperplasia (BPH), prostate cancer, and effects of radiation, and may also occur acutely after surgical treatment. Temporary intraprostatic stents have been investigated as a short-term alternative to external catheter drainage to permit volitional urination and avoid Foley bag use.

The FDA-approved device The Spanner™ is a temporary intraprostatic stent intended for short-term use (up to 30 days) to maintain urine flow after minimally invasive BPH procedures or initial post-treatment catheterization. Available data are inconclusive regarding effects on net health outcomes, and the procedure has not been shown to reliably improve long-term clinical benefit.

Definitions

Temporary prostatic stent — definition

TermTemporary prostatic stent

DefinitionA removable intraprostatic device designed for short-term use to allow voluntary urination and maintain patency of the prostatic urethra.

Intended useShort-term maintenance of urine flow after minimally invasive BPH procedures or initial post-treatment catheterization.

Regulatory noteThe Spanner™ received FDA premarket approval for temporary use up to 30 days to maintain urine flow and allow voluntary urination.

ExclusionsPolicy does not address permanent prostatic stents; only temporary removable stents are considered.

OpenPayer

Coverage policy for temporary (removable) prostatic urethral stents

Coverage Criteria for Temporary Prostatic Urethral Stents

Coding and Billing

Provider Actions and Administrative Requirements

Background

Definitions