Wiki CPT 52441 + 52442 BCBS

[PatriciaR]

Has anyone received reimbursement for cpt 52441+52441. We have been billing this procedure and it keeps getting denied as investigation/not medically necessary. This is for BCBS in the state of NY. Has anyone else been having issues? If so please provide any guidance.

Thank you.

 

[kathrynw]

Hello,

UroLift offers a host of information on prior authorization and contacting private payers to determine coverage on procedures of this nature. It might be helpful to read the information provided and custom tailor the information to your communication with BCBS of NY; as they could require HCPCS codes instead of CPT or they may require medical records.

https://www.urolift.com/physicians/reimbursement-details

Good Luck,

 

[CodingKing]

Empire Blue Cross policy medical policy: https://www.empireblue.com/medicalpolicies/policies/mp_pw_a053318.htm

The following procedures are considered investigational and not medically necessary for the treatment of benign prostatic hyperplasia:
Cryosurgical ablation;
or Prostatic arterial embolization;
or Prostatic urethral lift;
or Transurethral convective water vapor thermal ablation.