Medicare AdvantageCoverageMedium impact
MA11.004n, Minimally Invasive Treatments for Urinary Outlet Obstruction due to Benign Prostatic Hyperplasia (BPH)
Independence Blue Cross·Urology·Medical Policy
Effective date
Mar 24, 2025
We identified it
Jun 19, 2026
Summary
Medicare Advantage updated their policy MA11.004n for minimally invasive treatments for urinary outlet obstruction due to benign prostatic hyperplasia (BPH). The changes include updates to medical necessity criteria, medical coding requirements, and general guidelines for these procedures.
Action Required
By March 24, 2025: Billing team must review updated policy MA11.004n for BPH minimally invasive treatments to understand new medical necessity criteria and coding requirements. Update billing system documentation requirements and inform urology providers of any new prior authorization or documentation standards for Medicare Advantage patients receiving BPH treatments.