Overview:
Significant advancements have been made in prostate tissue ablation, particularly with the introduction of MRI-monitored Transurethral Ultrasound Ablation (TULSA). This innovative procedure offers a minimally invasive approach to treating prostate diseases, including prostate cancer and benign prostatic hyperplasia (BPH). In recognition of its clinical utility, the American Medical Association (AMA) has introduced new Category I Current Procedural Terminology (CPT) codes effective January 1, 2025, to accurately report and bill for TULSA procedures.
TULSA System:
- This system uses a transurethral ultrasound applicator for ultrasound ablation of prostate tissue under continuous magnetic resonance (MR) guidance and control.
- This FDA-cleared device is indicated for transurethral ultrasound ablation (TULSA) of prostate tissue.
TULSA Procedure:
Transurethral Approach:
- In this method, a device is inserted through the urethra to deliver thermal ultrasound energy (high heat) directed outward from the urethra toward the outer edge of the prostate.
- This technique eliminates the need for surgical incisions to access the prostate.
- By using the transurethral approach, direct thermal contact with the neurovascular bundles surrounding the prostate and the rectum is avoided, significantly reducing the risk of side effects such as erectile dysfunction and incontinence.
Thermal Protection of Critical Anatomy:
- The urethral cooling mechanism is designed to safeguard the urethra from thermal damage, ensuring that surrounding tissues remain protected during the procedure.
Robotically Driven Ultrasound Ablation with Closed-Loop Thermal Feedback Control:
- The thermal ultrasound energy is delivered in a directional pattern, enabling it to target a broader area of prostate tissue. This beam moves in a sweeping motion, which allows for efficient ablation of larger prostate volumes.
- The TULSA procedure incorporates real-time temperature mapping, providing the physician with continuous data on the temperature of both the prostate tissue and surrounding structures. Every 5 to 7 seconds, the physician can observe these temperature readings, allowing for precise control during the ablation process.
- This level of visibility helps the physician monitor tissue heating closely and make adjustments to the treatment as needed, ensuring the TULSA procedure remains both controlled and predictable.
CPT Codes for TULSA Procedure:
The 2025 CPT code updates include three specific codes for MRI-monitored transurethral ultrasound ablation of prostate tissue:
Coding guidelines for Professional services:
Reimbursement guidelines for Professional services:
CPT Codes: RVUs and MPFS Reimbursement (2025):
Explanation:
- Work RVUs: This reflects the time, skill, and effort required to perform the procedure, as determined by CMS.
- Facility MPFS Reimbursement: The reimbursement rate for hospital outpatient departments (HOPD) and ambulatory surgical centers (ASC), based on the final CMS rule for 2025.
- Non-Facility MPFS Reimbursement: The reimbursement rate for services provided in a non-facility setting such as a private office or physician’s clinic.
These rates can vary based on specific regional adjustments to Medicare fees. This table reflects the average or typical reimbursements as set by CMS for 2025
Coding guidelines for Facility services:
- The TULSA procedure may be performed in sites of service that are paid under different payment systems by Medicare.
- This procedure can be billed by both Hospital Outpatient Department AND Ambulatory Surgical Centers (ASCs) based on the place of service in which, this service was performed
CPT code for Facility Services:
- Both HOPD and ASC bill only code 55882
- CPT 55882 accurately reflects the facility's resource utilization
Note:
- As per Medicare, The codes 51721 and 55881 cannot be billed by HOPD, as these procedures have a Status Indicator “B,” meaning they are not recognized by OPPS.
- Similarly, the codes 51721 and 55881 cannot be billed by ASC, as they are not included in the ASC covered procedures list.
Reimbursement guidelines for Facility services:
HOPD Rates:
*Status Indicator = J1: The payment rate covers all items and services for the hospital outpatient encounter
**Ambulatory Payment Classification (APC) Level 7 Urology
ASC Rates:
Payment Indicator = J8: Device-intensive procedure; paid at adjusted rate
Office-Based Lab (OBL):
- It is important to note that the CPT codes 51721, 55881, and 55882 are all eligible for billing when the procedure is performed in an office-based setting.
- This means that physicians conducting Transurethral Ultrasound Ablation (TULSA) procedures in a private office or office-based laboratory (OBL) can report these specific codes for reimbursement.
- When conducting procedures in an Office-Based Lab (OBL) setting, physicians must choose the correct CPT code based on the specific components of the procedure they are performing. This ensures accurate billing and reflects the services provided.
Payor Policies May Differ and Should Be Verified Before Treatment:
It is essential to verify each payor’s specific policy and requirements for coverage before proceeding with the TULSA procedure. This helps ensure that the treatment is appropriately covered, the correct codes are used, and the site of service complies with insurer guidelines. By confirming these details in advance, healthcare providers can minimize the risk of denials, maximize reimbursement, and ensure smooth claims processing.
Conclusion:
The introduction of specific CPT codes for MRI-monitored Transurethral Ultrasound Ablation marks a significant advancement in the coding and billing landscape for prostate tissue ablation techniques. Accurate utilization of these codes ensures appropriate reimbursement and reflects the evolving practices in prostate disease management. Providers are encouraged to familiarize themselves with these updates to ensure compliance and optimal billing practices.
References:
AMA CPT manual 2025
Medicare Physician Fee Schedule RVU files 2025
Medicare ASC Fee Schedule January 2025
Medicare OCE Files January 2025
Profound TULSA 2025 Reimbursement: Quick Reference Guide
CODING TIPS & TRICKS Current Procedural Terminology Code Updates for 2025 of Interest to Urology
