Local Coverage Article Billing and Coding

Billing and Coding: Rezum® Procedure

A55352

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Contractor Information

Article Information

General Information

Article ID
A55352
Article Title
Billing and Coding: Rezum® Procedure
Article Type
Billing and Coding
Original Effective Date
11/10/2016
Revision Effective Date
12/26/2019
Revision Ending Date
N/A
Retirement Date
N/A
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CPT codes, descriptions and other data only are copyright 2021 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

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CMS National Coverage Policy

Social Security Act (Title XVIII) Standard References:

  • Title XVIII of the Social Security Act, Section 1833(e) states that no payment shall be made to any provider of services or other person under this part unless there has been furnished such information as may be necessary in order to determine the amounts due such provider or other person under this part for the period with respect to which the amounts are being paid or for any prior period.

Article Guidance

Article Text

This Billing and Coding Article provides billing and coding guidance for the Rezum® procedure for treatment of benign prostatic hyperplasia (BPH).

On August 27, 2015, the FDA cleared for marketing the Rezum® System to relieve lower urinary tract symptoms secondary to BPH. This procedure involves the transurethral injection of steam into the obstructive prostate tissue. Once injected, the steam condenses to water, imparting convective energy to the prostate tissue, causing cell death and damage. The technology uses radiofrequency (RF) to boil the water to create the steam that is injected but does not impart radiofrequency directly to the prostate tissue.

Coding Guidance:

Notice: It is not appropriate to bill Medicare for services that are not covered as if they are covered. When billing for non-covered services, use the appropriate modifier.

CPT code 53854 for Hospital Outpatient (Part A) and Ambulatory Surgical Center (Part B) Facility claims

Effective 1/1/2019, hospital outpatient departments (HOPDs) should use CPT code 53854 to report the use of the Rezum® procedure for the treatment of BPH.

For additional information, please refer to CMS federal regulations for Hospital Outpatient Regulations and Notices, final rule with comment period for the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for Calendar Year (CY) 2022 (CMS-1753-FC) located at: https://www.cms.gov/medicaremedicare-fee-service-paymenthospitaloutpatientpps/cms-1753-fc.

CPT code 53854 for Professional claims (Part B) Medicare Fee-For-Service (FFS)

CPT code 53852 (Transurethral destruction of prostate tissue; by radiofrequency thermotherapy), does not appropriately describe the Rezum® procedure. Effective 1/1/2019, claims for procedures involving Rezum® should be coded as CPT code 53854.

Documentation Requirements

  1. All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
  2. Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service[s]). The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
  3. The submitted medical record must support the use of the selected ICD-10-CM code(s). The submitted CPT/HCPCS code must describe the service performed.

Coding Information

CPT/HCPCS Codes

Group 1

(1 Code)
Group 1 Paragraph


Providers are reminded to refer to the long descriptors of the CPT codes in their CPT book.

Group 1 Codes
CodeDescription
53854 Trurl dstrj prst8 tiss rf wv

CPT/HCPCS Modifiers

N/A

ICD-10-CM Codes that Support Medical Necessity

N/A

ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

ICD-10-PCS Codes

N/A

Additional ICD-10 Information

N/A

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

CodeDescription
999x Not Applicable

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

CodeDescription
99999 Not Applicable

Other Coding Information

N/A

Revision History Information

Revision History DateRevision History NumberRevision History Explanation
12/26/2019 R6

Article revised and published 03/10/2022. The language “The claim, in block 19 on the CMS 1500 form (or its electronic equivalent), should indicate that the Rezum procedure was performed.” was removed from the Coding Guidance section. Also, the link to the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system final rule was updated. In addition, minor formatting changes were made throughout the Article.

12/26/2019 R5

Article revised and published 12/26/2019 to update the link under Reporting Guidelines.

11/21/2019 R4

Article revised and published on 11/21/2019. Due to system changes the order of the Coding Section has been revised and new sections for CPT/HCPCS Modifiers and Other Coding Information have been added.

01/01/2019 R3

Article revised and published on 02/14/2019 effective for dates of service on and after 01/01/2019 to reflect the annual CPT/HCPCS code updates. The following CPT/HCPCS code(s) have been deleted and therefore removed from the article: C9748. The following CPT/HCPCS code(s) have been added to Group 1 Codes: 53854. With the addition of the 2019 new CPT code 53854, CPT code 53899 (unlisted procedure, urinary system) has been removed from the article. The text in the article has been updated to reflect the 2019 CPT/HCPCS Updates.

01/01/2018 R2

Article revised and published on 01/25/2018 effective for dates of service on and after 01/01/2018 to reflect the annual CPT/HCPCS code updates. The following CPT/HCPCS code(s) have been added to the Group 1 codes: C9748. Added the header “Reporting Guidelines” with coding information for HCPCS code C9748 and clarification of existing coding information for CPT code 53899.

03/16/2017 R1 Article revised and published on 03/16/2017 to provide education regarding the Rezum® procedure for treatment of BPH.

Associated Documents

Related Local Coverage Documents
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Related National Coverage Documents
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Statutory Requirements URLs
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Rules and Regulations URLs
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CMS Manual Explanations URLs
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Other URLs
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Public Versions
Updated On Effective Dates Status
03/03/2022 12/26/2019 - N/A Currently in Effect You are here
12/19/2019 12/26/2019 - N/A Superseded View
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

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