Tuesday, March 19, 2024

Is Aquablation Covered By Medicare

Don't Miss

Retreatment Rates And Psa Changes

News4 at 4 – Aquablation: Surgical Robot Treats Enlarged Prostate

At 2yr, the Kaplan-Meier freedom from surgical retreatment was 95.7% in WATER and 98.0% in WATER II, with five and two patients, respectively, requiring surgical retreatment. Medical BPH retreatment at 2yr occurred in 4.3% of patients in WATER and 5.9% in WATER II. Figure 4 shows the Kaplan-Meier surgical retreatmentfree survival curve. Regarding changes in PSA, baseline PSA was 3.7ng/ml in WATER and 7.1ng/ml in WATER II at 2yr, PSA was 3.0ng/ml in WATER and 4.9ng/ml in WATER II. Figure 5 presents the change in PSA at 6, 12, and 24 mo the regression line is at or below the 50% reduction line for all time points.

Change in prostate-specific antigen at 6, 12, and 24 mo. *The regression line is at or below the 50% reduction line for all time points.

Transurethral Waterjet Ablation Of The Prostate

L38549

A and B and HHH MAC 11201 – MAC A
A and B and HHH MAC 11202 – MAC B
A and B and HHH MAC 11301 – MAC A
A and B and HHH MAC 11302 – MAC B
A and B and HHH MAC 11401 – MAC A
A and B and HHH MAC 11402 – MAC B
A and B and HHH MAC 11501 – MAC A
A and B and HHH MAC 11502 – MAC B

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is notrecommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services.The AMA assumes no liability for data contained or not contained herein.

Read Real Stories Of Men Who Underwent Treatment Of Enlarged Prostate At New York Urology Specialists

We offer treatment for prostate problems, including slow urine stream, frequent urination at night, difficulty emptying the bladder, and other problems to patients within driving distance to our offices as well as from other states and countries. Our patients come from New York, New Jersey, Pennsylvania, Connecticut, and over 70 countries worldwide.

Recommended Reading: Does Medicare Cover Labor And Delivery

Transurethral Water Vapor Thermal Therapy And Transurethral Water Jet Ablation For Bph

We comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, disability, or sex, including sexual orientation, gender identity, or gender expression. We also provide language assistance. Read our Nondiscrimination and Language Assistance notice.

All trademarks unless otherwise noted are the property of Blue Cross & Blue Shield of Rhode Island or the Blue Cross and Blue Shield Association. Blue Cross & Blue Shield of Rhode Island is an independent licensee of the Blue Cross and Blue Shield Association.

What Are The Risks Associated With Aquablation Therapy

Full Medicare Coverage for PROCEPT BioRobotics Aquablation Therapy

The most common side effects are mild and temporary. These may include mild pain, bleeding or strain while peeing, discomfort in the pelvis, inability to empty the bladder, a frequent and/or urgent need to urinate, and bladder or urinary tract infection. Other risks include ejaculatory dysfunction and a low risk of injury to the urethra or rectum. For more information about potential side effects and risks associated with Aquablation therapy, speak with your urologist or surgeon.

For more information, visit the Safety Information page.

You May Like: Does Medicare Cover Dental Emergencies

How Does Aquablation Treat Bph

Aquablation is a revolutionary treatment that combines water, precision, and imaging to safely and effectively resect prostatic tissue without compromising the patients sexual function and/or continence. During Aquablation in Jacksonville, FL, which is performed using general anesthesia and takes about one hour to complete, Dr. Kasraeian will insert a cystoscope through the urethra. This, along with ultrasound imaging, allows Dr. Kasraeian to create a map of the prostate. Using this map, Dr. Kasraeian can resect the appropriate tissue while avoiding resection in areas that may lead to incontinence or sexual dysfunction. Finally, a robotic system follows the maps guidelines to precisely ablate the tissue with a heat-free water stream, further reducing the possibility of side effects and/or surgical error.

Does Medicare Cover Aquablation

The short answer is yes. Medicare will cover the cost of Aquablation. But not 100% of the time. As is often the case with Medicare, certain conditions have to be met for Medicare to pay for your Aquablation.

First, lets take a look at what Aquablation therapy is. Then we will examine what conditions you have to meet in order to get coverage for Aquablation.

Also Check: Will Medicare Pay For A Bedside Commode

How Does Aquablation Therapy Work Plus

Aquablation therapy is a resective procedure, which means that the prostate tissue causing symptoms is surgically removed. No incision is made in the abdomen, as the prostate is reached through the urethra.

Aquablation therapy is performed at our hospital and is done under anesthesia. The procedure typically takes less than an hour and involves an overnight stay.

What Happens Immediately After The Aquablation Therapy

Aquablation: Surgical Robot Treats Enlarged Prostate | NBC4 Washington

As with most BPH procedures, you will wake up with a catheter following Aquablation therapy, which allows you to urinate while your urethra heals. Patients typically stay overnight in the hospital. While no one likes staying overnight in a hospital, the benefit with Aquablation therapy is that most patients end up leaving the hospital without a catheter.1,2,3

For more information on the Aquablation procedure and recovery, visit the Aquablation Therapy page.

References:1. Gilling, P, et al. Three-Year Outcomes after Aquablation Therapy Compared to TURP: Results from a Blinded Randomized Trial. Can J Urol. 2020 Feb 27:10072-10079.2. Bhojani, N, et al. Aquablation for Benign Prostatic Hyperplasia in Large Prostates : 1-Year Results. Urology. 2019 Jul 129:1-7.3. Data on file at PROCEPT BioRobotics.

Recommended Reading: How Do I Cancel Medicare Part A

For The Man Not Just His Prostate

Ask a man with Benign Prostatic Hyperplasia what he wants more than anything and the answer is simple: get life back to normal, get back to being him, be free again to do the things he used to do without compromising his lifestyle or confidence.

Youve given medications a shot, and now youre considering other options. Aquablation therapy is an advanced, minimally invasive BPH treatment that uses the power of water delivered with robotic precision.

Its a long-lasting solution with low rates of irreversible complications, giving you the confidence to live life on your terms. 1

Conditions Required For Medicare Coverage

Original Medicare will provide coverage for treatments for BPH, including Aquablation, if you meet the following conditions:

  • You have a prostate volume of 30-150 cc by transrectal ultrasound
  • You experience persistent moderate to severe symptoms
  • The FDA approves the treatment

Plans A and B do not require prior authorization for them to provide coverage for Aquablation treatment for BPH. Next, lets examine Medicare Advantage plans coverage.

Also Check: Can You Be Denied Medicare Coverage

Cost Of Treatment And Insurances

At New York Urology Specialists, we offer affordable treatment for men. Our prices are low for patients without insurance and for those who have high insurance copays, high deductibles, or insurance plans that do not cover treatment costs.

We accept many health insurance plans. We would be happy to verify your eligibility and benefits and to provide you with detailed information on your health plans coverage. and credit options are available to help you pay for medical care.

License For Use Of Physicians’ Current Procedural Terminology Fourth Edition

PROCEPT BioRobotics Announces Full Medicare Coverage for Aquablation ...

End User Point and Click Amendment:CPT codes, descriptions and other data only are copyright 2021 American Medical Association. American Medical Association. All Rights Reserved . CPT is a trademark of the American Medical Association .

You, your employees and agents are authorized to use CPT only as contained in the following authorized materials of CMS internally within your organization within the United States for the sole use by yourself, employees and agents. Use is limited to use in Medicare, Medicaid or other programs administered by the Centers for Medicare and Medicaid Services . You agree to take all necessary steps to insure that your employees and agents abide by the terms of this agreement.

Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. License to use CPT for any use not authorized herein must be obtained through the AMA, CPT Intellectual Property Services, AMA Plaza, 330 Wabash Ave., Suite 39300, Chicago, IL 60611-5885. Applications are available at the AMA Web site, .

Also Check: Do I Have Medicare Or Medicaid

Design Setting And Participants

We used data from two trials. WATER is a prospective, double-blind, multicenter, international clinical trial comparing the safety and efficacy of Aquablation and transurethral resection of the prostate in the treatment of LUTS/BPH in men aged 4580 yr with a prostate of 3080cm3. WATER II is a prospective, multicenter, single-arm international clinical trial of Aquablation in men with a prostate of 80150cm3.

What Is Aquablation Therapy

Aquablation therapy is a unique treatment. Its the only technique that combines a camera with ultrasound imaging to allow the surgeon to examine the entire prostate in real-time. Next, it uses a heat-free waterjet controlled by robotic technology to remove prostate tissue.

Lower urinary tract symptoms caused by BPH are proven to be safely and successfully treated with Aquablation.

Don’t Miss: What Is The New Medicare Plan

Procept Biorobotics Announces Full Medicare Coverage For Aquablation Therapy For Enlarged Prostate

REDWOOD CITY, Calif., November 16, 2020 PROCEPT® BioRobotics Corporation, a surgical robotics company developing intelligent solutions to transform the field of urology, today announced that Aquablation therapy, delivered by the AQUABEAM® Robotic System for the treatment of benign prostatic hyperplasia , will be fully covered for all Medicare patients in the United States effective December 27, 2020.

Medicare Administrative Contractors First Coast Service Options, Inc , Noridian Healthcare Solutions, LLC , Novitas Solutions, Inc. , GBA, LLC , and Wisconsin Physician Services issued positive Local Coverage Determination policies for Aquablation therapy effective December 27, 2020. These five MACs join National Government Services and CGS Administrators, LLC who issued positive coverage policies for Aquablation therapy effective November 2020.

This recent Medicare announcement compliments positive coverage positions issued earlier in 2020 from Anthem and Humana, two of the nations leading health insurance providers. Anthem and Humana insure more than 42 million and 7 million lives nationwide, respectively, through their commercial and Medicare Advantage products.

Media Contact:

Where To Get Prostate Aquablation Surgery In Nyc

At New York Urology Specialists, we offer specialized treatment for enlarged prostate for men. Same-day virtual video appointments and in-person appointments are available.

Call/text today: or make an appointment online.

We perform a cystoscopy, urodynamic testing, prostate and bladder ultrasound in our office. We offer Urolift procedure, Rezum water-vapor procedure in our office, and laser enucleation of the prostate in a hospital setting. We treat urinary and erection problems. We offer confidential appointments.

Our appointment costs are affordable with or without insurance. We offer free insurance verification.

You May Like: Is Any Dental Work Covered By Medicare

How Soon Can I Get Aquablation

Aquablation is currently in trials. It is likely that Aquablation will become available in the United States in 2021-2022.

At New York Urology Specialists, we plan to offer patients Aquablation soon. Please contact us for currently available options.

For patients, who have symptoms of BPH, we advise scheduling an appointment with us to discuss other very effective treatment options for enlarged prostate and urine retention such as Urolift for BPH, Rezum procedure, and laser enucleation of the prostate.

Did you know?Dr. Shteynshlyuger has performed over 1,000 surgeries and procedures for enlarged prostate, including Rezum, Urolift, prostate enucleation, laser ablation of the prostate, and TURP. He performs over 100 prostate procedures a year.

Why Is The Aquabeam Robotic Surgery Better

Aquablation therapy is a one-of-a-kind procedure. It is the only procedure that uses a heat-free waterjet controlled by robotic technology to remove prostate tissue and combines a camera with ultrasound imaging, giving the surgeon the ability to see the entire prostate in real time. As a result, Aquablation therapy is precise, consistent and predictable and provides long-term relief no matter how large your prostate is. It has a very low rate of irreversible complicationsincontinence, ejaculatory dysfunction, erectile dysfunction.1,2

Recommended Reading: Does Emory Hospital Accept Medicare

How Quickly Will I Recover

Typically, patients will stay overnight in the hospital.

When you wake up from your procedure, like all BPH procedures, you will have a catheter to help you relieve yourself while you heal. Before going home, your catheter will be removed and your doctor will ensure you can urinate on your own. You may be asked to stay an additional night if you have trouble urinating. However, you wont have a catheter once discharged.

Once home, you may experience a slight burning while urinating for a few weeks that you can help relieve with mild pain medication.

Does My Insurance Cover Aquablation Therapy

PROCEPT BioRobotics Announces Full Medicare Coverage for Aquablation ...

For patients in the United States, Medicare and several of the major national private insurance companies have issued positive coverage policies for their patients. For all other private insurance companies, coverage can be assessed on an individual basis, and you should speak with your provider directly to determine if Aquablation therapy is available for you.

For more information, visit our Insurance page.

For patients outside of the United States, reimbursement and coverage vary by geography. We recommend patients contact their local physician providers to determine if Aquablation therapy is available.

For more information, visit our Insurance page.

Read Also: Are Resident Aliens Eligible For Medicare

What Are The Chances That I Will Have Side Effects After Aquablation For Bph

If you have been avoiding BPH surgery because you are unwilling to sacrifice your sexual function or urinary continence, you are not alone. Believe it or not, an estimated 83% of men with BPH delay or defer surgical intervention because they do not want to risk how it may impact their sexual function. At Kasraeian Urology in Jacksonville, FL, board-certified urologists Drs. Ahmad and Ali Kasraeian understand the importance of balancing normal functionalities with BPH symptom relief and are proud to be among the first and only practices in the area to offer Aquablation therapy. Read on to find out more about why Aquablation may be the solution youve been looking for to improve your BPH symptoms without sacrificing your urinary or sexual function.

Cost Of Enlarged Prostate Treatment Without Insurance

At New York Urology Specialists, we offer affordable treatment for men. Our prices are low for patients without insurance and for those who have high insurance copays, high deductibles, or insurance plans that do not cover treatment costs.

At New York Urology Specialists, we offer a flat-fee all-cost-included Rezum procedure. The procedure is performed in our office under local anesthesia. Men from other states can save thousands of dollars over local hospital fees by coming to New York Urology Specialists for treatment. Please contact us for current prices and discounts for patients without insurance or with high insurance deductibles.

At New York Urology Specialists, we offer a flat-fee all-cost-included Urolift procedure. The procedure is performed in our office under local anesthesia. Men from other states can save thousands of dollars over local hospital fees by coming to New York Urology Specialists for treatment.

Don’t Miss: Does Medicare Cover Outpatient Services

Imaging And Other Investigations

Uroflowmetry is done to measure the rate of urine flow and total volume of urine voided when the subject is peeing.

Abdominal ultrasound examination of the prostate and kidneys is often performed to rule out hydronephrosis and hydroureter. Incidentally, cysts, tumours, and stones may be found on ultrasound. Post-void residual volume of more than 100 ml may indicate significant obstruction. Prostate size of 30 cc or more indicates enlargement of the prostate.

Prostatic calcification can be detected through transrectal ultrasound . Calcification is due to solidification of prostatic secretions or calcified corpora amylacea . Calcification is also found in a variety of other conditions such as prostatitis, chronic pelvic pain syndrome, and prostate cancer. For those with elevated levels of PSA, TRUS guided biopsy is performed to take a sample of the prostate for investigation. Although MRI is more accurate than TRUS in determining prostate volume, TRUS is less expensive and almost as accurate as MRI. Therefore, TRUS is still preferred to measure prostate volume.

Medical conditions

Medications

What Are The Benefits Of Aquablation Therapy

Aquablation is the only procedure that allows the surgeon to see your whole prostate in real time, giving your surgeon the ability to create a surgical map of the prostate and identify the parts that are causing problems.

With Aquablation therapy, only the tissue causing the problems is removed. The prostate is reached via the urethra, so theres no incision.

In clinical studies, men who had Aquablation therapy had low rates of irreversible complications, such as incontinence and erectile dysfunction, and studies show the therapy provides long-term relief.

Recommended Reading: Does Medicare Cover Home Delivered Meals

What Is Recovery Like After Aquablation Therapy

As with most BPH procedures, you will wake up with a catheter following Aquablation therapy, which allows you to urinate while your urethra heals. Patients typically stay overnight in the hospital. While no one likes staying overnight in a hospital, the benefit with Aquablation therapy is that most patients end up leaving the hospital without a catheter.1,2,3

Once youre home, you may experience mild burning during urination for a couple of weeks. This can be managed with mild pain medication. Patients can resume their normal activities once approved by their doctor.

To find out more about recovery, visit the Aquablation Therapy page.

References:1. Gilling, P, et al. Three-Year Outcomes after Aquablation Therapy Compared to TURP: Results from a Blinded Randomized Trial. Can J Urol. 2020 Feb 27:10072-10079.2. Bhojani, N, et al. Aquablation for Benign Prostatic Hyperplasia in Large Prostates : 1-Year Results. Urology. 2019 Jul 129:1-7.3. Data on file at PROCEPT BioRobotics.

More articles

Popular Articles