A: In December 2014, the American Urological Association’s Coding and Reimbursement Committee determined that CPT code 53852 (Transurethral destruction of prostate tissue; by radiofrequency thermotherapy) should be used to report the transuretheral needle ablation procedure using the Rezūm System.1
To report the Rezūm procedure on medical claims, use CPT® code 53852 Transurethral destruction of prostate tissue; by radiofrequency thermotherapy. The Rezūm System uses radiofrequency energy to transform sterile water into stored thermal energy in the form of vapor, or steam. This water vapor is convectively delivered directly into the obstructive prostate tissue that causes BPH, where condensation releases enough thermal energy to denature the targeted prostate tissue cells to cause necrosis. The treated tissue is absorbed by the body’s natural immune system. It is intended to relieve symptoms, obstruction, and reduce prostate tissue associated with benign prostatic hyperplasia (BPH). It is also indicated for treatment of prostates with hyperplasia of the central zone and/or a median lobe.
However, the AUA is not an official rule making organization with regard to payment policy. Therefore, you will need to check with payers on appropriate coding polices which at the writing of this guide were in a state of change. Some private payers and two of the Medicare Carriers have instructed physicians billing for the Rezūm to use code 53899 Unlisted procedure, urinary system. When using 53899 it is advisable to insert “Rezūm Transurethral destruction of prostate tissue; by radiofrequency thermotherapy” in box 19 of the claim form to assure prompt payment. Expect a request for medical records from some payers until such time as the payer has established a coverage policy for the procedure. For Patients with Private payer coverage including some Medicare Advantage plans it is advisable to request prior authorization for the service.
A: Many Medicare Administrative Contractors (MACs) consider radiofrequency thermotherapy ablation reported using CPT code 53852 medically necessary for treating patients with BPH. However, there are a few MACs that have developed specific Local Coverage Decisions (LCD) that may require reporting with code 53899 Unlisted procedure, urinary system and to insert “Rezūm Transurethral destruction of prostate tissue; by radiofrequency thermotherapy” in box 19 of the claim form to assure prompt payment. In the absence of an LCD or LCA, report 53852.
A: Most payers consider CPT code 53852 medically necessary for patients with benign prostatic hypertrophy (BPH). Providers should always verify a patient’s benefits and any prior authorization requirements prior to scheduling a procedure.
Note: that some payers may require reporting with code 53899 Unlisted procedure, urinary system and to insert “Rezūm Transurethral destruction of prostate tissue; by radiofrequency thermotherapy” in box 19 of the claim form to assure prompt payment.
A: The Rezūm System is a technology used to perform thetransurethral RF thermotherapy procedure to treat BPH, and is reported using CPT code 53852. For the majority of payers, this procedure code is not on their prior authorization list. It is advised, however, that you check with patients’ individual health plans for their policy on prior authorization and pre-certification requirements for CPT code 53852 and or policies related to Rezūm. If a patient’s payer requires prior authorization, this should occur prior to the procedure being provided. Remember you are seeking authorization for the Rezum procedure under code 53852 for those payers not requring the use of 53899. NxThera can provide information that will help you with this process, including sample letters. Should you need assistance, please contact 303-225-0362.
A: If conscious sedation is used during an office based, RF thermotherapy BPH ablation procedure, an independent, trained observer is required to be present to monitor the patient’s status. When these services are provided by the surgeon they may be reported using CPT codes 99152-99153. The intraservice time begins with the administration of the agent and concludes at the end of personal contact with the patient by the physician providing the sedation. Billing of these services requires continuous face-to-face attendance. Please note that coverage for Conscious Sedation varies by benefit plan and should be researched prior to performance of the service.
A: CPT code 53852 includes administration of a prostate block and transrectal ultrasound, if performed. These services should not be reported separately as they are considered bundled and included in the payment for the surgical procedure. Code 53852 also has a 90 day global period assigned to the procedure, therefore services related to the procedure provided the day before the procedure, the day of the procedure and for 90 days after the procedure are included, with the exception of those services provided for laboratory and radiology services. The office may also report some services considered staged or unrelated to the procedure within the global period with proper modifiers as documented and required.
1. American Urological Association: Prostate Procedures Coding and Reimbursement Q&A. https://www.auanet.org/resources/biopsy-procedures.cfm.