Urinary

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Surgery & Injections

Indicates Non-Covered Service

Ablative

Therapy of Renal Lesions

Benign Prostatic Hypertrophy (BPH) Treatments

-Aetna-

-Anthem-

Brachytherapy for Clinically Localized Prostate Cancer Using Permanently Implanted Seeds

Circumcision - Medical Indications

-UHC-

Collagenase Clostridium Histolyticum (Xiaflex ®)

-Anthem-

-Cigna-

Cryoablation

of the

Prostate

-Aetna-

-Cigna-

-UHC-

Cryosurgery of the Prostate

-Medicare-

Enhanced Cystoscopy for Bladder Cancer

Extracorporeal Shock Wave Lithotripsy (ESWL)

-UHC-

Focal Laser Ablation for the Treatment of Prostate Cancer

-Anthem-

Gender Reassignment Surgery

High Intensity Focused Ultrasound

-Aetna-

-Cigna-

Hydrocel-ectomy

-UHC-

Incision & Drainage of Abscess of Skin, Subcutaneous & Accessory Structures

Laser Ablation Prostate

-Medicare-

Male Urethral Sling

Erectile Dysfunction Diagnosis & Treatment

-Aetna-

Male Sexual Dysfunction Treatment: Nonpharmac-logic

-Cigna-

Minimally Invasive Treatment for Benign Prostatic Hyperplasia Involving Prostatic Urethral Lift (Urolift)

-Medicare-

Multipara-metric Magnetic Resonance Fusion Imaging Targeted Prostate Biopsy

Neurogenic Bladder Treatment

-Aetna-

Nocturnal Enuresis Treatments

-Aetna-

Outpatient Cystourethros-

copy

-Anthem-

Penile Circumcision

-Anthem-

Penile Prosthesis Implantation

-Anthem-

Periurethral Injections of Bulking Agents

Vesicoureteral Reflux Treatment by Endoscopic Injection of Bulking Agents

-Aetna-

Percutaneous Tibial Nerve Stimulation

-FloridaBlue-

Percutaneous Tibial Nerve Stimulation & Sacral Nerve Stimulation for Urinary & Fecal Incontinence; Urinary Retention

Posterior Tibial Nerve Stimulation (PTNS) for Urinary Control

-Centene-

Prostate Cancer Screening

-Aetna-

Prostate Rectal Spacers

-Medicare-

Prostate-Specific Antigen (PSA) Screening for Prostate Cancer

Prostatec-tomy

-Humana-

Prostate Biopsy

-Aetna-

Prostate Biopsy using MRI Fusion Techniques

-Anthem-

Prostate Saturation Biopsy

-FloridaBlue-

Scrotal Ultrasond

-Aetna-

Surgical & Invasive Treatments for Overactive Bladder

Surgical & Minimally Invasive Treatments for Urinary Outlet Obstruction due to Benign Prostatic Hyperplasia (BPH)

Surgical & Minimally Invasive Treatment for BPH

-Anthem-

Transperineal Placement of Biodegradable Material (Space OAR) for Prostate Cancer

Transrectal Ultrasound

-Anthem-

Prostate Surgical Interventions

-UHC-

Transurethral Waterjet Ablation of the Prostate

-Medicare-

Treatment of Kidney Stones

-Medicare-

UHC Outpatient Surgical Procedures - Site of Service Criteria: Male Genital System

UHC Outpatient Surgical Procedures - Site of Service Criteria: Urinary System

Ureteroscopy

-UHC-

Urethroplasty

-UHC-

Urinary Bladder Dysfunction Treatment

-Humana-

Urinary Incontinence Devices & Treatment

-Aetna-

-Anthem-

-Cenetene-

Urinary Symptom Score Change 6-12 Months After Diagnosis of Benign Prostatic Hyperplasia (CMS771v3)

Urodynamics

-Medicare-

Uroflowmetric Evaluations

Varicocele

Treatment

-Aetna-

Vasectomy Procedures

-Aetna-

Water Vapor Thermal Therapy for LUTS/BPH)

Whole Gland Cryoablation of Prostate Cancer

-Medicare-

-FloridaBlue-

Indicates Non-Covered Service

Artificial Intelligence-Based Software for Prostate Cancer Detection

-Anthem-

Interstitial Motexafin Lutetium-mediated Photodynamic Therapy for Prostate Cancer

Focal Laser Ablation for the Treatment of Prostate Cancer

-Anthem-

Nerve Graft after Prostatectomy

-Anthem-

Pelvic Floor Stimulation as a Treatment of Incontinence

-FloridaBlue-

Prostate Mapping Biopsy

-Anthem-

Prostate Saturation Biopsy

-Anthem-

-Aetna-

Transvaginal Radiofrequency Bladder Neck Suspension and Transurethral Radiofrequency Tissue Remodeling for Urinary Stress Incontinence

Radiofrequency Ablation Renal Sympathetic Nerves

-Anthem-

-FloridaBlue-