Cryosurgery of Prostate
Cryosurgery of the prostate gland, also known as cryosurgical ablation of the prostate (CSAP), destroys prostate tissue by applying extremely cold temperatures in order to reduce the size of the prostate gland. It is safe and effective, as well as medically necessary and appropriate, as primary treatment for patients with clinically localized prostate cancer, Stages T1-T3.
Cryosurgery of the prostate as a salvage therapy is not covered for any services performed prior to June 30, 2001.
Salvage Cryosurgery of Prostate After Radiation Failure. Salvage cryosurgery of the prostate for recurrent cancer is medically necessary and appropriate only for those patients with localized disease who:
Cryosurgery as salvage therapy is therefore not covered under Medicare after failure of other therapies as the primary treatment. Cryosurgery as salvage is only covered after the failure of a trial of radiation therapy, under the conditions noted above.
03/1997 - Provided noncoverage policy. Effective date 04/15/1997. (TN 93)
04/1999 - Allowed coverage only for primary treatment for patients with clinically localized prostate cancer, Stages T1-T3. Effective date 07/01/1999. (TN 110)
06/2001 - Expanded coverage for those patients who failed a trial of radiation treatment and met one of the limitations set forth in policy. Effective and implementation dates 07/01/2001. (TN 140) (1632)
09/2012 - CMS translated the information for this policy from ICD-9-CM/PCS to ICD-10-CM/PCS according to HIPAA standard medical data code set requirements and updated any necessary and related coding infrastructure. These updates do not expand, restrict, or alter existing coverage policy.Implementation date: 01/07/2013 Effective date: 10/1/2015. (TN 1122) (TN 1122) (CR 7818)
This NCD has been or is currently being reviewed under the National Coverage
Determination process. The following are existing associations with NCAs, from the National
Coverage Analyses database.