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Issue Number - Name
0134-Cryosurgery of the Prostate
Review Type
Complex
Claim Type
Outpatient Hospital, Ambulatory Surgical Center (ASC), Physician/Non-physician Practitioner
Region and State
RAC 1-4
All A/B MACs
Date Approved
2019-01-08

Description

Claims for Cryosurgery of the Prostate are not deemed to be medically necessary based on the guidelines outlined in the Centers for Medicare and Medicaid National Coverage Determination Manual (Publication 100-03, Part 4, Section 230.9)

Affected Codes

55873 - Cryosurgical Ablation of the Prostate (includes ultrasonic guidance and monitoring)

Applicable Policy References

Social Security Act: Section 1862(a)(1)(A)- Exclusions from Coverage and Medicare as a Secondary Payer
Social Security Act: Section 1833(e)- Payment of Benefits
42 CFR, Section 405.986 Good Cause for Reopening
42 CFR, Section 405.980 (b) and (c) 
CMS Pub. 100-03, Medicare National Coverage Determinations Manual, Part 4, Section 230
CMS Pub. 100-04, Medicare Claims Processing Manual, Chapter 32, Section 180