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Proposed LCD for Water Vapor Thermal Therapy for LUTS/BPH (DL37808)

The obstructing median lobe requirement was removed. Only this change is open for Official Comment.


Contractor Information

Contractor Name Contract Type Contract Number Jurisdiction State(s)
National Government Services, Inc. MAC - Part A 06101 - MAC A J - 06 Illinois
National Government Services, Inc. MAC - Part B 06102 - MAC B J - 06 Illinois
 
National Government Services, Inc. MAC - Part A 06201 - MAC A J - 06 Minnesota
 
National Government Services, Inc. MAC - Part B 06202 - MAC B J - 06 Minnesota
 
National Government Services, Inc. MAC - Part A 06301 - MAC A J - 06 Wisconsin
 
National Government Services, Inc. MAC - Part B 06302 - MAC B J - 06 Wisconsin
 
National Government Services, Inc. A and B and HHH MAC 13101 - MAC A J - K Connecticut
 
National Government Services, Inc. A and B and HHH MAC 13102 - MAC B J - K Connecticut
 
National Government Services, Inc. A and B and HHH MAC 13201 - MAC A J - K New York - Entire State
 
National Government Services, Inc. A and B and HHH MAC 13202 - MAC B J - K New York - Downstate
 
National Government Services, Inc. A and B and HHH MAC 13282 - MAC B J - K New York - Upstate
National Government Services, Inc. A and B and HHH MAC 13292 - MAC B J - K New York - Queens
National Government Services, Inc. A and B and HHH MAC 14111 - MAC A J - K Maine
National Government Services, Inc. A and B and HHH MAC 14112 - MAC B J - K Maine
National Government Services, Inc. A and B and HHH MAC 14211 - MAC A J - K Massachusetts
National Government Services, Inc. A and B and HHH MAC 14212 - MAC B J - K Massachusetts
 
National Government Services, Inc. A and B and HHH MAC 14311 - MAC A J - K New Hampshire
 
National Government Services, Inc. A and B and HHH MAC 14312 - MAC B J - K New Hampshire
 
National Government Services, Inc. A and B and HHH MAC 14411 - MAC A J - K Rhode Island
 
National Government Services, Inc. A and B and HHH MAC 14412 - MAC B J - K Rhode Island
 
National Government Services, Inc. A and B and HHH MAC 14511 - MAC A J - K Vermont
 
National Government Services, Inc. A and B and HHH MAC 14512 - MAC B J - K Vermont

LCD Information

Document Information

Source LCD ID

L37808

Proposed LCD ID

DL37808

Proposed LCD Title

Water Vapor Thermal Therapy for LUTS/BPH

AMA CPT / ADA CDT / AHA NUBC Copyright Statement

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CMS National Coverage Policy

Language quoted from Centers for Medicare and Medicaid Services (CMS), National Coverage Determinations (NCDs) and coverage provisions in interpretive manuals is italicized throughout the policy. NCDs and coverage provisions in interpretive manuals are not subject to the LCD Review Process (42 CFR 405.860[b] and 42 CFR 426 [Subpart D]). In addition, an administrative law judge may not review an NCD. See Section 1869(f)(1)(A)(i) of the Social Security Act. 

Unless otherwise specified, italicized text represents quotation from one or more of the following CMS sources:

Title XVIII of the Social Security Act (SSA):

Section 1862(a)(1)(A) excludes expenses incurred for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.

Section 1862(a)(1)(D) refers to limitations on items or devices that are investigational or experimental.

Section 1833(e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim.

CMS Publications:

CMS Publication 100-02, Medicare Benefit Policy Manual, Chapter 14, 

10 Coverage of Medical Devices 

CMS Publication 100-04, Medicare Claims Processing Manual, Chapter 23, 

30 Services paid under the Medicare Physicians Fee Schedule 

CMS Publication 100-08, Medicare Program Integrity Manual, Chapter 13, 

5.1 Reasonable and necessary provisions in LCDs 

7.1 Evidence supporting LCDs. 


Coverage Guidance

Coverage Indications, Limitations, and/or Medical Necessity

This LCD addresses use of water vapor thermal therapy for the treatment of lower urinary tract symptoms attributable to benign prostatic hyperplasia (LUTS/BPH). 

ONE treatment for LUTS/BPH treatment is covered ONCE in patients with BOTH the following: 

  1. Indications including ALL of the following:

    1. Age 50

    2. Symptomatic despite maximal medical management including ALL of the following:

      1. International Prostate Symptom Score (IPSS) ≥13

      2. Maximum urinary flow rate (Qmax) of ≤15 mL/s (voided volume greater than 125 cc)

      3. Failure, contraindication or intolerance to at least three months of conventional medical therapy for BPH (e.g., alpha blocker, PDE5 Inhibitor, finasteride/dutasteride)

    3. Prostate volume of 30-80 cc,

    4. Poor candidate for other surgical interventions for BPH due to underlying disease (e.g., cardiac disease, pulmonary disease, etc.), or at high risk of bleeding

  2. No contraindications including ALL of the following:

    1. Known or suspected prostate cancer (based on NCCN Prostate Cancer Early Detection guidelines) or a prostate specific antigen (PSA) >10 ng/mL

    2. Active urinary tract infection

    3. History of bacterial prostatitis in the past three months

    4. Urinary retention (e.g., PVR >250-300 mL, catheterization requirement, history of being unable to void)

    5. Prior prostate surgery

    6. Neurogenic bladder

    7. Active urethral stricture (i.e., the source of the current LUTS)

Summary of Evidence

Approximately 50 percent of men at age 50, and up to 80 percent at age 80, have LUTS/BPH (1). In 2015, it was estimated that 12.2 million men were actively managed for LUTS/BPH; accounting for almost 25% of a urology practice (2). An aging population means the impact of LUTS/BPH will only increase. BPH develops primarily in the periurethral or transitional zone of the prostate (normally only 5% of prostate volume), and its pathogenesis remains incompletely understood. The natural history is variable; about one-third will ultimately require treatment, one-third remain stable, and one-third have some spontaneous regression of symptoms.  

The array of therapeutic options includes conservative approaches (watchful waiting), pharmacotherapy, and a burgeoning variety of surgical options (transurethral prostate resection or ablation). The need for surgical intervention is generally based upon the adequacy of medical therapy, the development of complications, and patient preference, rather than any specific urological parameter (3). The American Urologic Association/International Prostate Symptom Score (AUA/IPSS) (assessing for both storage (frequency, nocturia, urgency), and voiding (weak urinary stream, hesitancy, intermittence, incomplete emptying) symptoms, is useful for quantifying and monitoring BPH symptoms. Symptoms (individually ranked 0-5) are classified as mild (total score 0-7), moderate (total score 8-19), or severe (total score 20-35). Surgery is usually reserved for those with moderate to severe symptoms despite medical management (insufficient efficacy and tolerability, including drug side effects involving sexual dysfunction) (4). 

Transurethral resection of the prostate (TURP) has been the standard-of-care for decades. However, despite technical refinements that have improved safety, the procedure is still associated with a perioperative morbidity rate of 20% and long-term complications like ejaculatory dysfunction (EjD) (65%), erectile dysfunction (ED) (10%), urethral strictures (7%), urinary tract infection (4%), bleeding requiring transfusion (2%), urinary incontinence (2%) and a retreatment rate of 6% (5). EjD has a significant negative impact on quality-of-life (QoL), including on fertility, considering the relatively early onset of BPH.  

In recent years, an alphabet soup of minimally invasive treatment options have emerged with the main goal to be equally effective to TURP but with a more favorable safety and convenience profile. Ideally, this includes the rapid and durable relief of LUTS without compromise of sexual function, under local anesthesia in an ambulatory setting, with a short convalescence (6). Increasingly, a balance between symptomatic improvement in LUTS and preservation of sexual function is expected (7). The most apt comparators to water vapor thermal therapy include transurethral needle ablation (TUNA), and transurethral microwave thermotherapy (TUMT), both minimally invasive thermal ablative techniques.  

Transurethral needle ablation (TUNA)  

TUNA delivers radiofrequency energy to the prostate via needles inserted transurethrally into the prostatic parenchyma. The energy induces coagulation necrosis in the prostatic transition zone resulting in prostate volume reduction and LUTS reduction. There may also be a poorly understood neuromodulatory effect (8).  

Detailed comparisons between TUNA and other treatments can be found in two comprehensive, systematic reviews and meta-analyses (9,10). Improvements in urodynamic and symptom score parameters are generally inferior to TURP but TUNA is considered an alternative for men who are poor candidates for surgery, particularly men who require anticoagulation, but also for those who wish to undergo a procedure with fewer lower urinary and sexual side effects than TURP.      

Transurethral microwave therapy (TUMT)  

TUMT of the prostate works by emitting microwave radiation through an intra-urethral antenna in order to deliver heat into the prostate. Tissue is destroyed by being heated at temperatures above cytotoxic thresholds (> 45°C) (coagulation necrosis). It is thought that the heat generated by TUMT also causes apoptosis and denervation of alpha-receptors, thereby decreasing the smooth muscle tone of the prostatic urethra (8).  

A Cochrane systematic review of all available randomized controlled trials (RCTs) on TUMT shows roughly similar therapeutic efficacy to TUNA (11).  

Water vapor thermal therapy

Water vapor thermal therapy uses convective water vapor energy to ablate prostatic tissue. The Rezum system for delivering water vapor thermal therapy received FDA 510(k) clearance in 2015 to treat LUTS/BPH in men ≥ 50 years old with a prostate volume 30-80cc, and includes treatment of hyperplasia of the central prostate zone and median lobe (12).  

This technology uses radiofrequency current to generate “wet” thermal energy in the form of water vapor (steam). Using a TUNA approach, the steam is injected into the hyperplastic prostate, passing through the tissue interstices and disrupting cell membranes to effect rapid cell death and necrosis. Unlike conductive thermal ablation (TUNA, TUMT), steam convection at a physical phase change boundary best realizes a “prescribed temperature boundary condition”, effectively precluding a temperature gradient beyond the targeted prostate (usually the transition zone) (13). This was confirmed by histologic and imaging studies using gadolinium enhanced MRI (14,15). According to the manufacturer, water vapor thermal therapy requires “fewer joules per gram of tissue, ~1/6–1/23, to produce cell necrosis in prostate tissue compared to TUNA and TUMT, respectively (16).”  

A prospective, open-label, multicenter, pilot study reported the 1- and 2-year outcomes of 65 men with IPSS defined moderate (32.3%) to severe (67.7%) LUTS (overall mean IPSS: 21.6; Qmax: 7.9 mL/s; prostate volume (PV) 48.6 cc) (17,18). Clinically and statistically significant improvements in urinary symptoms were evident as early as one month after treatment and optimal at 3–12 months. The maximum IPSS improvement (-13.4) occurred at 3 months (N=62) and gradually decreased (-12.1) at 24 months (N=43); both were significantly different from baseline (p<.001). The maximum Qmax improvement (4.7 mL/s) occurred at 3 months (N=61) and decreased to (3.7 mL/s) at 24 months (N=39); both were significantly different from baseline (p<.001). Prostate volume was reported significantly decreased at all time points (p≤0.001). Adverse events were reported to be transient and mild to moderate, primarily related to endoscopic instrumentation. No clinically significant changes in sexual function were reported.  

A retrospective study analyzed 131 consecutive patients with moderate (53.1%) to severe (46.9%) LUTS treated with water vapor thermal therapy by seven urologists in a large group-community practice (19). While patient demographics were similar to the pilot study, some notable differences included older mean age (70.9 years), broader range of prostate volumes (mean 45.1 [12.9-183] cc), and higher post-void residual (PVR) volumes (mean 216.8 [0-2,000] mL, and three in retention. The maximum IPSS improvement (-10.1, -47.2%) occurred at 3-6 months (N=115) and decreased (-9.4, -45.2%) at 12 months (N=87); both were significantly different from baseline (p<.0001). The maximum Qmax improvement (3.0 mL/s, 75.3%) occurred at 3-6 months (N=38) but was markedly decreased (1.5 mL/s, 51.4%) at 12 months (N=7); only the 3-6 month value was significantly different from baseline (p=0.0388). PVR was significantly decreased at all time points. The safety profile was similar to the pilot study.  

The single level 1 study of water vapor thermal therapy is a multicenter RCT involving 197 men ≥50 years old with an IPPS ≥13, Qmax ≤15 mL/s, and PV 30-80 cc, randomized to thermal therapy with Rezum System or control (2:1) (20-22). Rigid cystoscopy with simulated active treatment sound effects served as the control procedure. The primary end point was the IPSS at 3 months. Both IPSS and Qmax (but not PVR) were significantly improved relative to sham at 3 months (p<0.0001). After the 3-month blinded comparison, 53 of 61 control subjects enrolled in a separate crossover active treatment study. The original active treatment group was followed annually for 3 years. The maximum IPSS improvement (-12.2, -54%) occurred at 6 months (N=129) and decreased (-11.0, -50%) at 36 months (N=97); both were significantly different from baseline (p<.0001). The greatest Qmax improvement (6.4 mL/s, 69%) occurred at 3 months (N=125) and decreased markedly (3.5 mL/s, 39%) by 36 months (N=80); both were significantly different from baseline (p<.0001). The surgical retreatment rate was 4.4 percent (6/135) over three years (open prostatectomy (1), plasma-button transurethral vaporization (3), water vapor thermal therapy re-treatment (2)). Subjects with a median lobe or central zone hyperplasia achieved similar significant relief of symptoms. Sexually active subjects had no negative changes in the International Index of Erectile Function (IIEF-15) and Male Sexual Health Questionnaire for Ejaculatory Dysfunction (MSHQ-EjD) function scores throughout 3 years of follow-up. Adverse events reported were infrequent and of short duration. The most common were dysuria (16.9%), hematuria (11.8%), frequency and urgency (5.9%), acute urinary retention (3.7%), and suspected urinary tract infection (3.7%); all were treated routinely or resolved without treatment within 3 weeks. There were no late occurring related adverse events.  Four year results were reassuring, with IPSS relatively stable (-10.1, -46.7%, N=90), and Qmax improved (4.2 mL/s, 49.5%, N=81) (33). The surgical retreatment rate was unchanged at 4.4%.

The table below compares the mid-term (3-4 -year) results of water vapor thermal therapy with traditional comparators (the subjective IPSS and objective Qmax are the almost universal primary outcome measures). 

Image of the Mid-term Thermal Ablation Results versus Traditional Comparators cahrt showing the differnece between the two.

Analysis of Evidence
(Rationale for Determination)

The European Association of Urology (EAU) guidelines state that TUNA and TUMT “achieve symptom improvement comparable with TURP, but both are associated with decreased morbidity and lower flow improvements. Durability is in favour of TURP with lower re-treatment rates compared to TUMT. (Level of evidence 1a, Grade A) (8).” The National Institute for Health and Care Excellence (NICE) guidelines do not recommend their use over TURP for men with LUTS/BPH (31). They are silent regarding water vapor thermal therapy as both predate water vapor thermal therapy study publication. UpToDate includes a summary of the 3-year water vapor thermal therapy data but makes no specific recommendation (3). Longstanding American Urological Association (AUA) guidelines considered both TUNA and TUMT “an appropriate and effective treatment alternative for bothersome moderate or severe LUTS secondary to BPH (30)." However, recently-issued, new guidelines no longer recommend TUNA based on “expert opinion,” and “conditionally recommend” both TUMT and water vapor thermal therapy (“evidence level: Grade C”) (32). The water vapor thermal therapy statement, based on the one RCT’s two-year data, is particularly cautious, noting “patients should be informed that evidence of efficacy, including longer-term retreatment rates, remains limited.”

Compared to TUNA and TUMT, water vapor thermal therapy data is limited in time (mid-term), scope (no studies comparing water vapor thermal therapy to other surgical options), and independence (no studies independent of manufacturer funding, and at least some author conflict of interest (“financial interest and/or other relationship with NxThera”)). The lack of long-term results is particularly important in view of the relatively low IPSS and Qmax percent improvement after water vapor thermal therapy at 3 years. Especially concerning is the sudden drop in Qmax improvement (53% to 39%) between years two and three, as this objective outcome metric is less subject to the placebo effect than IPSS (20,24,25). However, just published 4-year results show Qmax to have rebounded from the downward trajectory, allaying concerns somewhat.

The perception exists that utilization of TUNA and TUMT has not reached initial expectations due to insufficient long-term durability, despite advantages in more convenience and lower morbidity (30). Mid-term results suggest that durability after water vapor thermal therapy is no better, and may even be worse, than TUNA and TUMT. The new AUA water vapor thermal therapy recommendation based on one study’s two-year data seems premature, especially in light of the subsequent Qmax drop from year two to three. Conversely, unlike TUNA and TUMT, water vapor thermal therapy offers the potential for a low morbidity treatment of median lobe LUTS. NGS, therefore, will tentatively cover water vapor thermal therapy treatment for LUTS/BPH in poor surgical candidates, under criteria otherwise largely based on the RCT, pending long-term data.


Proposed Process Information

Changes Fields Changes
The obstructing median lobe requirement has been removed from the following sections in the LCD - Coverage Indications, Limitations and/or Medical Necessity, Summary of Evidence and Analysis of Evidence (Rationale for Determination).

The bibliography has been updated to add an additional reference.
Coverage Indications Limitations and/or Medical Necessity
Associated Information
Sources of Information and Basis for Decision

Associated Information

N/A

Sources of Information

N/A

Bibliography

  1. Cunningham GR, Kadmon D. Clinical manifestations and diagnostic evaluation of benign prostatic hyperplasia. Uptodate 2017; UpToDate
  2. Vuichoud C, Loughlin KR. Benign prostatic hyperplasia: epidemiology, economics and evaluation. Can J Urol. 2015;22 Suppl 1:1-6.
  3. Cunningham GR, Kadmon D. Transurethral procedures for treating benign prostatic hyperplasia. Uptodate 2018; UpToDate
  4. Cindolo L, Pirozzi L, Fanizza C, et al. Drug adherence and clinical outcomes for patients under pharmacological therapy for lower urinary tract symptoms related to benign prostatic hyperplasia: population-based cohort study. Eur Urol. 2015;68(3):418-425.
  5. McVary KT, Roehrborn CG, Avins AL, et al. Update on AUA guideline on the management of benign prostatic hyperplasia. J Urol. 2011;185(5):1793-1803.
  6. Chung ASJ, Woo HH. Update on minimally invasive surgery and benign prostatic hyperplasia. Asian J Urol. 2018;5(1):22-27.
  7. Sturch P, Woo HH, McNicholas T, Muir G. Ejaculatory dysfunction after treatment for lower urinary tract symptoms: retrograde ejaculation or retrograde thinking? BJU Int. 2015;115(2):186-187.
  8. European Association of Urology. Guidelines on the management of non-neurogenic LUTS-BPH. 2014; https://uroweb.org/wp-content/uploads/Non-Neurogenic-Male-LUTS_2705.pdf.
  9. Bouza C, Lopez T, Magro A, Navalpotro L, Amate JM. Systematic review and meta-analysis of Transurethral Needle Ablation in symptomatic Benign Prostatic Hyperplasia. BMC Urol. 2006;6:14.
  10. Boyle P, Robertson C, Vaughan ED, Fitzpatrick JM. A meta-analysis of trials of transurethral needle ablation for treating symptomatic benign prostatic hyperplasia. BJU Int. 2004;94(1):83-88.
  11. Hoffman RM, Monga M, Elliott SP, et al. Microwave thermotherapy for benign prostatic hyperplasia. Cochrane Database Syst Rev. 2012(9):CD004135.
  12. Rezum FDA 510K clearance. 2015; https://www.accessdata.fda.gov/cdrh_docs/pdf15/K150786.pdf.
  13. Hahn DW. Heat Conduction Fundamentals. In: Heat Conduction. 3rd ed. Hoboken, NJ: John Wiley & Sons, Inc.; 2012.
  14. Dixon CM, Rijo Cedano E, Mynderse LA, Larson TR. Transurethral convective water vapor as a treatment for lower urinary tract symptomatology due to benign prostatic hyperplasia using the Rezum((R)) system: evaluation of acute ablative capabilities in the human prostate. Res Rep Urol. 2015;7:13-18.
  15. Mynderse LA, Hanson D, Robb RA, et al. Rezum System Water Vapor Treatment for Lower Urinary Tract Symptoms/Benign Prostatic Hyperplasia: Validation of Convective Thermal Energy Transfer and Characterization With Magnetic Resonance Imaging and 3-Dimensional Renderings. Urology. 2015;86(1):122-127.
  16. Woo HH, Gonzalez RR. Perspective on the Rezum((R)) System: a minimally invasive treatment strategy for benign prostatic hyperplasia using convective radiofrequency water vapor thermal therapy. Med Devices (Auckl). 2017;10:71-80.
  17. Dixon C, Cedano ER, Pacik D, et al. Efficacy and Safety of Rezum System Water Vapor Treatment for Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia. Urology. 2015;86(5):1042-1047.
  18. Dixon CM, Cedano ER, Pacik D, et al. Two-year results after convective radiofrequency water vapor thermal therapy of symptomatic benign prostatic hyperplasia. Res Rep Urol. 2016;8:207-216.
  19. Darson MF, Alexander EE, Schiffman ZJ, et al. Procedural techniques and multicenter postmarket experience using minimally invasive convective radiofrequency thermal therapy with Rezum system for treatment of lower urinary tract symptoms due to benign prostatic hyperplasia. Res Rep Urol. 2017;9:159-168.
  20. McVary KT, Gange SN, Gittelman MC, et al. Minimally Invasive Prostate Convective Water Vapor Energy Ablation: A Multicenter, Randomized, Controlled Study for the Treatment of Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia. J Urol. 2016;195(5):1529-1538.
  21. Roehrborn CG, Gange SN, Gittelman MC, et al. Convective Thermal Therapy: Durable 2-Year Results of Randomized Controlled and Prospective Crossover Studies for Treatment of Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia. J Urol. 2017;197(6):1507-1516.
  22. McVary KT, Roehrborn CG. Three-Year Outcomes of the Prospective, Randomized Controlled Rezum System Study: Convective Radiofrequency Thermal Therapy for Treatment of Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia. Urology. 2018;111:1-9.
  23. Gupta N, Rogers T, Holland B, Helo S, Dynda D, McVary KT. Three-year treatment outcomes of water vapor thermal therapy (Rezum System) compared to doxazosin, finasteride and combination drug therapy for men with benign prostatic hyperplasia: cohort data from the Medical Therapy of Prostatic Symptoms (MTOPS) Trial. J Urol. 2018.
  24. Welliver C, Kottwitz M, Feustel P, McVary K. Clinically and Statistically Significant Changes Seen in Sham Surgery Arms of Randomized, Controlled Benign Prostatic Hyperplasia Surgery Trials. J Urol. 2015;194(6):1682-1687.
  25. van Leeuwen JH, Castro R, Busse M, Bemelmans BL. The placebo effect in the pharmacologic treatment of patients with lower urinary tract symptoms. Eur Urol. 2006;50(3):440-452; discussion 453.
  26. Mattiasson A, Wagrell L, Schelin S, et al. Five-year follow-up of feedback microwave thermotherapy versus TURP for clinical BPH: a prospective randomized multicenter study. Urology. 2007;69(1):91-96; discussion 96-97.
  27. Marra G, Sturch P, Oderda M, Tabatabaei S, Muir G, Gontero P. Systematic review of lower urinary tract symptoms/benign prostatic hyperplasia surgical treatments on men's ejaculatory function: Time for a bespoke approach? Int J Urol. 2016;23(1):22-35.
  28. Zlotta AR, Giannakopoulos X, Maehlum O, Ostrem T, Schulman CC. Long-term evaluation of transurethral needle ablation of the prostate (TUNA) for treatment of symptomatic benign prostatic hyperplasia: clinical outcome up to five years from three centers. Eur Urol. 2003;44(1):89-93.
  29. Strope SA, Vetter J, Elliott S, Andriole GL, Olsen MA. Use of Medical Therapy and Success of Laser Surgery and Transurethral Resection of the Prostate for Benign Prostatic Hyperplasia. Urology. 2015;86(6):1115-1122.
  30. AUA: Benign Prostatic Hyperplasia (2010; Reviewed and Validity Confirmed 2014). 2010; AUA
  31. NICE BPH Guideline. 2010; https://www.nice.org.uk/guidance/cg97.
  32. Surgical Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia (2018). http://www.auanet.org/guidelines/surgical-management-of-lower-urinary-tract-symptoms-attributed-to-benign-prostatic-hyperplasia-(2018).
  33. McVary KT, Rogers T, Roehrborn CG. Rezum Water Vapor Thermal Therapy for Lower Urinary Tract Symptoms Associated With Benign Prostatic Hyperplasia: 4-Year Results From Randomized Controlled Study. Urology. 2019.

Open Meetings

Meeting Date Meeting State(s) Meeting Information
06/27/2019 Connecticut
Illinois
Maine
Massachusetts
Minnesota
New Hampshire
New York - Downstate
New York - Entire State
New York - Queens
New York - Upstate
Rhode Island
Vermont
Wisconsin
12:00-1:30 p.m. CT
Illinois State Medical Society
20 N. Michigan Avenue Suite
700 Michigan Room
Chicago, IL. 60602

Contractor Advisory Committee (CAC) Meetings

N/A

MAC Meeting Information URL(s)

N/A

Proposed LCD Posting Date

06/06/2019

Comment Period Start Date

06/06/2019

Comment Period End Date

07/20/2019

Released to Final LCD Date

Please Note: This is not the LCD Effective Date.

N/A

Reason for Proposed LCD

    • Provider Education/Guidance
    • Public Education/Guidance
    • Request for Coverage by a Practitioner (Part B)

Proposed Contact

Virginia Muir
LCD Comments
P.O. Box 7108
Indianapolis, IN 46207-7108
PartBLCDComments@anthem.com


Coding Information

Bill Type Codes:

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.

N/A

Revenue Codes:

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the policy, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.

N/A

CPT/HCPCS Codes

Group 1 Paragraph:
Refer to Coding Article A56590

Group 1 Codes:

Code Description
XX000 Not Applicable

ICD-10 Codes that Support Medical Necessity

Group 1 Paragraph:
Refer to Coding Article A56590

Group 1 Codes:

ICD-10 Code Description
XX000 Not Applicable

ICD-10 Codes that DO NOT Support Medical Necessity

N/A

Additional ICD-10 Information

N/A


Associated Documents

Attachments

N/A

Related Local Coverage Documents

Article(s)
A56590 - Billing and Coding: Water Vapor Thermal Therapy for LUTS/BPH

Related National Coverage Documents

N/A


Keywords

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Proposed LCD for Water Vapor Thermal Therapy for LUTS/BPH (DL37808)
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