Does C2596 require prior authorization?

No, C2596 does not require prior authorization (high confidence). Covered without prior authorization.

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`C2596`, Probe, image-guided, robotic, waterjet ablation

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

When required, the name and NPI of the referring/ordering physician must be reported on the claim.
The claim must include a valid ICD-10-CM diagnosis code that best describes the patient's condition for which the service was performed.
Providers should verify and comply with applicable NCCI and OPPS requirements prior to billing Medicare for these procedures.
Maintain all documentation in the patient's medical record and make it available to the contractor upon request.
Every page of the record must be legible and include appropriate patient identification information, including complete name and dates of service.
The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care.

Key Coverage Criteria

Transurethral waterjet ablation of the prostate is covered only when it is reasonable and necessary and the patient meets the clinical criteria specified in Local Coverage Determination (LCD) L38712.
Transurethral waterjet ablation of the prostate is covered only when it meets the reasonable and necessary requirements specified in Local Coverage Determination L38726.
Procedures using devices that have been approved for marketing by the FDA (including 510(k) cleared devices) may be considered for Medicare coverage when the service is reasonable and necessary to treat illness or injury as determined by the A/B Medicare Administrative Contractors (A/B MACs).
Procedures performed within qualifying clinical trials that meet the National Coverage Determination (NCD) for Routine Costs in Clinical Trials (310.1) or within FDA-approved Investigational Device Exemption (IDE) trials may be covered for routine costs and otherwise reasonable and necessary services.
International Prostate Symptom Score (IPSS) of greater than or equal to 12.
Maximum urinary flow rate (Qmax) of less than or equal to 15 mL/s on uroflowmetry.

20 Active Policies

CGS-J15-L38378, Fluid Jet System in the Treatment of Benign Prostatic Hyperplasia (BPH)

J15

CGS-J18-L38378, Fluid Jet System in the Treatment of Benign Prostatic Hyperplasia (BPH)

J18

WPS-J5-L38682, Transurethral Waterjet Ablation of the Prostate

A58209, Billing and Coding: Transurethral Waterjet Ablation of the Prostate

WPS-J5-L40194, Transurethral Waterjet Ablation of the Prostate

WPS-J5-L35490, Category III Codes

NGS-J6-L38367, Fluid Jet System Treatment for LUTS/BPH

A56797, Billing and Coding: Fluid Jet System Treatment for LUTs/BPH

WPS-J8-L38682, Transurethral Waterjet Ablation of the Prostate

WPS-J8-L40194, Transurethral Waterjet Ablation of the Prostate

WPS-J8-L35490, Category III Codes

A58264, Billing and Coding: Transurethral Waterjet Ablation of the Prostate

FIRST_COAST-L38726, Transurethral Waterjet Ablation of the Prostate

NORIDIAN-JE-L38705, Transurethral Waterjet Ablation of the Prostate

NORIDIAN-JF-L38705, Transurethral Waterjet Ablation of the Prostate

NOVITAS-JH-L38712, Transurethral Waterjet Ablation of the Prostate

PALMETTO-JJ-L38549, Transurethral Waterjet Ablation of the Prostate

NGS-JK-L38367, Fluid Jet System Treatment for LUTS/BPH

A58243, Billing and Coding: Transurethral Waterjet Ablation of the Prostate

NOVITAS-JL-L38712, Transurethral Waterjet Ablation of the Prostate

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C2596, Probe, image-guided, robotic, waterjet ablation

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

When required, the name and NPI of the referring/ordering physician must be reported on the claim.
The claim must include a valid ICD-10-CM diagnosis code that best describes the patient's condition for which the service was performed.
Providers should verify and comply with applicable NCCI and OPPS requirements prior to billing Medicare for these procedures.
Maintain all documentation in the patient's medical record and make it available to the contractor upon request.
Every page of the record must be legible and include appropriate patient identification information, including complete name and dates of service.
The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care.

Key Coverage Criteria

Transurethral waterjet ablation of the prostate is covered only when it is reasonable and necessary and the patient meets the clinical criteria specified in Local Coverage Determination (LCD) L38712.
Transurethral waterjet ablation of the prostate is covered only when it meets the reasonable and necessary requirements specified in Local Coverage Determination L38726.
Procedures using devices that have been approved for marketing by the FDA (including 510(k) cleared devices) may be considered for Medicare coverage when the service is reasonable and necessary to treat illness or injury as determined by the A/B Medicare Administrative Contractors (A/B MACs).
Procedures performed within qualifying clinical trials that meet the National Coverage Determination (NCD) for Routine Costs in Clinical Trials (310.1) or within FDA-approved Investigational Device Exemption (IDE) trials may be covered for routine costs and otherwise reasonable and necessary services.
International Prostate Symptom Score (IPSS) of greater than or equal to 12.
Maximum urinary flow rate (Qmax) of less than or equal to 15 mL/s on uroflowmetry.

20 Active Policies

CGS-J15-L38378, Fluid Jet System in the Treatment of Benign Prostatic Hyperplasia (BPH)

J15

CGS-J18-L38378, Fluid Jet System in the Treatment of Benign Prostatic Hyperplasia (BPH)

J18

WPS-J5-L38682, Transurethral Waterjet Ablation of the Prostate

A58209, Billing and Coding: Transurethral Waterjet Ablation of the Prostate

WPS-J5-L40194, Transurethral Waterjet Ablation of the Prostate

WPS-J5-L35490, Category III Codes

NGS-J6-L38367, Fluid Jet System Treatment for LUTS/BPH

A56797, Billing and Coding: Fluid Jet System Treatment for LUTs/BPH

WPS-J8-L38682, Transurethral Waterjet Ablation of the Prostate

WPS-J8-L40194, Transurethral Waterjet Ablation of the Prostate

WPS-J8-L35490, Category III Codes

A58264, Billing and Coding: Transurethral Waterjet Ablation of the Prostate

FIRST_COAST-L38726, Transurethral Waterjet Ablation of the Prostate

NORIDIAN-JE-L38705, Transurethral Waterjet Ablation of the Prostate

NORIDIAN-JF-L38705, Transurethral Waterjet Ablation of the Prostate

NOVITAS-JH-L38712, Transurethral Waterjet Ablation of the Prostate

PALMETTO-JJ-L38549, Transurethral Waterjet Ablation of the Prostate

NGS-JK-L38367, Fluid Jet System Treatment for LUTS/BPH

A58243, Billing and Coding: Transurethral Waterjet Ablation of the Prostate

NOVITAS-JL-L38712, Transurethral Waterjet Ablation of the Prostate

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`C2596`, Probe, image-guided, robotic, waterjet ablation

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`C2596`, Probe, image-guided, robotic, waterjet ablation

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

C2596, Probe, image-guided, robotic, waterjet ablation

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

C2596, Probe, image-guided, robotic, waterjet ablation

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`C2596`, Probe, image-guided, robotic, waterjet ablation

`C2596`, Probe, image-guided, robotic, waterjet ablation