Prostate Surgeries and Interventions
Clinical coverage guidance for prostate surgeries and minimally invasive interventions (e.g., ablation, cryoablation, prostatic urethral lift, water vapor thermotherapy, water jet ablation, prostate artery embolization) outlining when services are considered medically necessary or not for Colorado Rocky Mountain Health Plans members.
Replaced language clarifying that prostatic urethral lift is proven and medically necessary for treating urinary symptoms caused by BPH when performed according to FDA labeled indications, contraindications, warnings, and precautions.
Revised list of FDA labeled indications for prostatic urethral lift to note lateral and median lobe hyperplasia.
Clarified that high-energy water vapor thermotherapy for prostate cancer (in individuals not meeting listed criteria) and other non-listed indications is unproven and not medically necessary.
Replaced language regarding transurethral water jet ablation, marking indications not listed as unproven and not medically necessary.
Revised list of proven and medically necessary indications for prostate artery embolization, including adding specific indications.
Removed 'individuals with BPH who are ineligible for other procedures due to surgical constraints (i.e., prostate size) or anesthesia risk (i.e., comorbidities)'.
Added 'irreversible electroporation ablation' to the revised list of unproven and not medically necessary indications.
Added CPT code 55877 to the Applicable Codes / Summary of Changes.
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.