Back to dashboard
Medicare AdvantageCoverageHigh impact

Benign Prostatic Hyperplasia Treatments - Medicare Advantage (Revised)

Humana·IA, KS, MO, NE, IN, MI, IL, MN, WI, CT, MA, ME, NH, NY, RI, VT, KY, OH, CA, HI, NV, AS, GU, MP, AK, AZ, ID, MT, ND, OR, SD, UT, WA, WY, AR, CO, LA, MS, NM, OK, TX, DE, DC, MD, NJ, PA, AL, GA, TN, NC, SC, VA, WV, FL, PR, VI · Urology·Medicare Advantage
Effective date
Aug 3, 2026
We identified it
Jul 30, 2026
Days to comply
—

Summary

This is a comprehensive Medicare Advantage policy for Benign Prostatic Hyperplasia (BPH) treatments that became effective on August 3, 2026. The policy outlines coverage for multiple surgical and minimally invasive treatment modalities including TURP, laser therapies, temporary implanted devices, and stents, with specific coverage determinations varying by MAC jurisdiction. Billing teams must verify applicable MAC-specific LCDs and NCDs by geographic location before processing BPH treatment claims.

Action Required

Action needed
By August 3, 2026: Billing team must obtain and integrate all applicable MAC-specific Local Coverage Determinations (LCDs) and Local Coverage Articles (LCAs) into the billing system based on patient geographic location. Cross-reference the MAC jurisdiction table provided (J5, J6, J8, J15, JE, JF, JH, JL, JJ, JN) with the applicable states/territories to determine correct coverage rules before processing claims. Update encounter forms and prior authorization workflows to require documentation of medical necessity per MAC guidelines. Medical coders must verify that submitted claims align with the specific LCD requirements for the patient's MAC jurisdiction (e.g., L38682, L38367, L38378, L38705, L38712, L38549, L38726 and corresponding LCAs). Failure to apply correct MAC-specific rules will result in claim denials or recoupment. Notify providers that TUMT and TUNA are considered legacy technologies and may have restricted coverage under current AUA guidelines.

Related policy hubs

Humana policiesIA policy changesKS policy changesMO policy changesNE policy changesIN policy changesMI policy changesIL policy changesMN policy changesWI policy changesCT policy changesMA policy changesME policy changesNH policy changesNY policy changesRI policy changesVT policy changesKY policy changesOH policy changesCA policy changesHI policy changesNV policy changesAS policy changesGU policy changesMP policy changesAK policy changesAZ policy changesID policy changesMT policy changesND policy changesOR policy changesSD policy changesUT policy changesWA policy changesWY policy changesAR policy changesCO policy changesLA policy changesMS policy changesNM policy changesOK policy changesTX policy changesDE policy changesDC policy changesMD policy changesNJ policy changesPA policy changesAL policy changesGA policy changesTN policy changesNC policy changesSC policy changesVA policy changesWV policy changesFL policy changesPR policy changesVI policy changesUrology