Superseded Local Coverage Article

Billing and Coding: Water Vapor Thermal Therapy for LUTS/BPH

A56590

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Contractor Information

Article Information

General Information

Article ID
A56590
Article Title
Billing and Coding: Water Vapor Thermal Therapy for LUTS/BPH
Article Type
Article
Original Effective Date
12/01/2019
Revision Effective Date
N/A
Revision Ending Date
N/A
Retirement Date
N/A
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Article Guidance

Article Text

This article contains coding guidelines that complement the Local Coverage Determination (LCD) for Water Vapor Thermal Therapy for LUTS/BPH (L37808). 

Coding Information:

Procedure codes may be subject to National Correct Coding Initiative (NCCI) edits or OPPS packaging edits. refer to NCCI and OPPS requirements prior to billing Medicare. 

For services requiring a referring/ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim. 

A claim submitted without a valid ICD-10-CM diagnosis code will be returned to the provider as an incomplete claim under Section 1833(e) of the Social Security Act.

The diagnosis code(s) must best describe the patient's condition for which the service was performed. 

Coding Information

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.

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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.

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CPT/HCPCS Codes

Group 1

(1 Code)
Group 1 Paragraph

Report unlisted procedure 53899, urinary system (when specified as Rezum) for dates of service prior to 1/1/2019.

Group 1 Codes
CodeDescription
53854 TRANSURETHRAL DESTRUCTION OF PROSTATE TISSUE; BY RADIOFREQUENCY GENERATED WATER VAPOR THERMOTHERAPY

ICD-10-CM Codes that are Covered

Group 1

(1 Code)
Group 1 Paragraph

N/A

Group 1 Codes
CodeDescription
N40.1 Benign prostatic hyperplasia with lower urinary tract symptoms

ICD-10-CM Codes that are Not Covered

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Revision History Information

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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
02/02/2023 04/01/2023 - N/A Currently in Effect View
10/02/2019 12/01/2019 - 03/31/2023 Superseded View
05/30/2019 12/01/2019 - N/A Superseded You are here

Keywords

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