Reimbursement for Aquablation Therapy

Reimbursement for Aquablation Therapy

Patient reimbursement information may be found on our patient website by clicking here.

PROCEPT BioRobotics is committed to educating and supporting healthcare professionals about Aquablation reimbursement. This section contains reimbursement information that may be useful for understanding and navigating the insurance process.

United States Reimbursement
Aquablation Therapy is a Benign Prostatic Hyperplasia (BPH) surgical therapy that received FDA clearance in December 2017. The Aquablation procedure enjoys widespread insurance coverage by both national and regional insurance payers.

Coverage – Traditional Medicare and Medicare Advantage Plans
Aquablation is covered for all Medicare enrollees in the US when medical necessity criteria are met.

Coverage – Private Payers
Aquablation therapy is covered by the following national commercial payers when medical necessity criteria are met.

  • Aetna
  • Anthem
  • Cigna
  • Humana

In addition, many Blue Cross and Blue Shield plans cover Aquablation including: CareFirst BCBS, Highmark BCBS, Independence BC, BCBS of Tennessee, BCBS Massachusetts, BCBS North Dakota and the Health Care Service Corporation (HCSC) Blue Cross Blue Shield Plans (BCBS TX, IL, OK, NM, and MT) . Other regional payers who cover Aquablation include Pacific Source, Medical Mutual and Emblem Health.

The list of payers covering Aquablation will be updated as additional positive coverage is attained.

Prior Authorization – Medicare
Traditional Medicare does not require prior authorization. The Medicare Advantage Plans (Medicare Part C) will likely require a prior authorization.

Prior Authorization – Private Insurance
Private insurers may require prior authorization for Aquablation Therapy. Prior authorization requirements vary by payer and patient plan.

Denials and Appeals
Providers and patients have the right to appeal prior authorization denials, claim denials and insufficient payment. Each payer has a defined appeals process and timely filing requirements. Appeals ensure that patient and provider denial issues are given appropriate consideration and review appeals also may address payer non-coverage.

International Reimbursement
Reimbursement and coverage vary by geography in markets outside the US. We recommend patients contact their local physician providers to determine if Aquablation Therapy is available.

To Request More Information
To request assistance with reimbursement questions or prior authorization, please contact us directly.

For a copy of the Aquablation Therapy Coding Reference Guide click here

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The information provided in this document was obtained from third-party sources and is subject to change without notice as a result of changes in reimbursement laws, regulations, rules, policies, and payment amounts. All content is, general in nature, and does not cover all situations or all payers’ rules and policies. It is the responsibility of the hospital or physician to determine medical necessity, the proper site for delivery of any services and to submit appropriate codes, modifiers and charges for a particular patient and/or procedure. Any claim should be coded appropriately and supported with adequate documentation in the medical record. . Reimbursement policies can vary considerably from one region or payer to another and may change over time PROCEPT BioRobotics encourages providers to submit claims for services consistent with FDA clearance and approved labeling.