Many patients wonder about their eligibility for insurance coverage when they undergo a minimally invasive in-office BPH procedure. Most patients who are looking to undergo an in-office BPH procedure will have one or more of the following insurance types: Private, Medicare and Medicaid.
While private insurance coverage varies between states, insurance companies and insurance plans, most private health insurers cover Transurethral Microwave Thermotherapy (Cooled ThermoTherapy) and Transurethral Needle Ablation (Prostiva RF Therapy). You should contact your insurance company and speak to your urologist’s billing team to learn more about any pre-authorizations that need to be performed.
Further, your insurer may require certain qualification criteria to be met before they cover the procedure.
Medicare covers both Cooled Thermotherapy and Prostiva RF Therapy. Because Medicare is a national payer, the requirements are the same across every state in the US. You may speak to your urologist or call Medicare directly to learn more about the insurance process.
Medicare Advantage may have separate requirements including a pre-authorization. Please verify coverage requirements with your urologist’s billing department or Medicare.
Medicaid coverage varies between states. Therefore, if you are looking to understand your coverage options you should contact the Medicaid office in your particular state. You may also speak to your urologist’s billing team to learn more.