Prostate Surgeries and Interventions (for Tennessee Only)
Medical policy governing coverage and medical necessity criteria for various prostate procedures (e.g., transurethral ablation, cryoablation, prostatic urethral lift, water vapor thermotherapy, water jet ablation, prostate artery embolization, and other novel procedures) for Medicaid and CoverKids members in Tennessee.
Removed coverage criteria for transperineal placement of biodegradable material.
Revised coverage criteria for prostatic urethral lift to allow treatment of lateral lobe with or without median lobe hyperplasia in men 45 years of age or older.
Clarified that transurethral water jet ablation is unproven and not medically necessary for malignant prostate tissue and all other indications not listed as proven.
Replaced language to state prostate artery embolization is proven and medically necessary for individuals with BPH who are ineligible for other procedures due to surgical constraints or anesthesia risk.
Added CPT codes 51721, 53865, 53866, 55881, and 55882; removed CPT code 55874.
Added 'transurethral thermal ultrasound ablation (TULSA)' to the list of unproven and not medically necessary procedures.
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.