Medicare AdvantageCoverageMedium impact
MA11.004p, Surgical and Minimally Invasive Treatments for Urinary Outlet Obstruction due to Benign Prostatic Hyperplasia (BPH)
Independence Blue Cross·Urology·Medical Policy
Effective date
Jul 28, 2025
We identified it
Jun 19, 2026
Summary
Medicare Advantage has updated the medical necessity criteria for surgical and minimally invasive treatments for urinary outlet obstruction due to benign prostatic hyperplasia (BPH). This change affects coverage requirements and approval processes for BPH-related procedures.
Action Required
By July 28, 2025: Billing team must review updated medical necessity criteria for BPH surgical procedures. Update prior authorization workflows and documentation requirements for Medicare Advantage BPH cases. Ensure providers document medical necessity according to new criteria to avoid claim denials.