Insurance Coverage | Insurance Coding

Coding and Coverage

CPT^® and HCPCS codes are considered the universal language between physicians and insurance companies for describing services provided. Physicians will utilize two distinct CPT codes for reporting prostatic urethral lift (PUL) using the UroLift^® System. CPT code 52441 is used by the physician to report the placement of the initial implant; CPT code 52442 is used to report the delivery of each additional implant. The number of implants will vary due to the unique characteristics of the prostate.

Hospitals and Ambulatory Surgery Centers will use either HCPCS code C9739 or C9740 to report PUL to Medicare, depending on the number of implants delivered. Commercial insurance companies may require CPT or HCPCS codes for facility claims.

Covered by Medicare, all national and commercial plans, including all independent licensees of Blue Cross Blue Shield Association (BCBSA), when medical criteria are met. To learn more about the insurance company(s) important to you, check with the Teleflex Interventional Urology Reimbursement Team at (844) 516-5966 or by email at uroliftreimbursement@teleflex.com.

Prior Authorization

Medicare

The Medicare program does not require prior authorization for the prostatic urethral lift using the UroLift System.

Commercial Payers

Prior authorization is recommended for prostatic urethral lift treatments. If required, the treating physician's office should work with the insurance company to obtain prior authorization prior to initiating treatment.

Although uncommon, prior authorization for treatment may be denied. If this happens, patients and/or physicians have the right to appeal the denial. If necessary, patients should consult with their physician's office to understand the appeal process.

For general information about how or when to submit an appeal, contact the Teleflex Interventional Urology Reimbursement Team toll free at (844) 516-5966 or by email at uroliftreimbursement@teleflex.com.

Denials & Appeals

Whether a prior authorization denial, treatment denial or insufficient payment occurs, patients and physicians have the right to appeal. The appeal process ensures critical patient treatment decisions are given appropriate consideration by the insurance company. Patients and physicians should follow the insurance company's defined appeal process.

Disclaimer: The information contained in this document is publicly available information obtained from third-party sources, may not be all-inclusive and is subject to change without notice. Content is informational only and does not constitute medical, legal or reimbursement advice nor is it intended as direction to the health care provider/user. Nothing herein constitutes any statement, promise or guarantee of payment. The provider is solely responsible for determining appropriate treatment for the patient based on the unique medical needs of each patient and the independent judgment of the provider. It is also the responsibility of the provider to determine payer appropriate coding, medical necessity, site of service, documentation requirements and payment levels and to submit appropriate codes, modifiers and charges for services rendered. Although we have made every effort to provide information that is current at the time of its issue, it is recommended that you consult your legal counsel, reimbursement/compliance advisor and/or payer organization(s) for interpretation of payer-specific coding, coverage and payment expectations.

Teleflex LLC encourages providers to submit claims for services that are appropriately and accurately consistent with FDA clearance and approved labeling and does not promote the use of its products outside their FDA-cleared labeling.

Rates referenced in this guide do not reflect sequestration adjustments which are automatic reductions in federal spending that will result in a 2% across-the- board reduction to all Medicare rates as of July 1, 2022. Quoted rates also do not reflect payment adjustments related to quality of and/or meaningful use.