Provider Alert! Updates for Prostate Surgeries Procedure Codes

Provider Alert!

Provider Alert! Updates for Prostate Surgeries Procedure Codes

Date: August 24, 2021

Attention: Urologists

Effective Date: October 1, 2021

Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event.  TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event.

Call to action: Effective for dates of service on or after October 1, 2021, reimbursement rate updates for Prostate Surgeries procedure codes will be implemented.

How this impacts providers: The following Procedures Codes are included in the reimbursement rate update.

  • 52441- Cystourethroscopy, with insertion of permanent adjustable transprostatic implant; single implant
  • 52442- Cystourethroscopy, with insertion of permanent adjustable transprostatic implant; each additional permanent adjustable transprostatic implant (List separately in addition to code for primary procedure)
  • 52649- Laser enucleation of the prostate with morcellation, including control of postoperative bleeding, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, internal urethrotomy and transurethral resection of prostate are included if performed)
  • 53852- Transurethral destruction of prostate tissue; by radiofrequency thermotherapy
  • 53855- Insertion of a temporary prostatic urethral stent, including urethral measurement
  • C9739- Cystourethroscopy, with insertion of transprostatic implant; one to three implants
  • C9740- Cystourethroscopy, with insertion of transprostatic implant; four or more implants

 

Next steps for providers: Texas Children’s Health Plan will follow the following age restrictions.

Code Age Range
52441 21-999
52442 21-999
52649 21-999
53852 0-20
53852 21-999
53855 0-20
53855 21-999

 

If you have any questions, please email Provider Network Management at: providerrelations@texaschildrens.org.
For access to all provider alerts, log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.

Share this post

Leave a Reply

Your email address will not be published. Required fields are marked *