Blogs

Insurance Updates: September 17th – September 23rd

By Policy and Advocacy Brief
Each week, the AUA publishes weekly updates on the latest insurance issues pertaining to urology. This week’s update includes the release of policies regarding Posterior Tibial Nerve Stimulation for Voiding Dysfunction, Magnetic Resonance Imaging (MRI)-Guided Focused Ultrasound Ablation, Prostatic Urethral Lift and UroLift for Benign Prostatic Hypertrophy, Prostate Cancer Targeted Therapies, and Erectile Dysfunction. Absolute Total Care, Ambetter of Alabama, Ambetter of Oklahoma, et al. Absolute Total Care, Ambetter of Alabama, Ambetter of Oklahoma, et al, reviewed Posterior Tibial Nerve Stimulation for Voiding Dysfunction with changes to ...
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Insurance Updates: September 10th – September 16th

By Policy and Advocacy Brief
Each week, the AUA publishes weekly updates on the latest insurance issues pertaining to urology. This week’s update includes the release of policies regarding Urological Supplies, Prostatic Urethral Lift/UroLift for Benign Prostatic Hypertrophy, Prostate Specific Antigen (PSA) Testing, Percutaneous and Subcutaneous Tibial Nerve Stimulation, Cellular Immunotherapy for Prostate Cancer, Intensity-Modulated Radiotherapy of the Prostate, and Nerve Graft with Radical Prostatectomy. Aetna Aetna reviewed Urological Supplies with changes to criteria, supplementary information, and formatting. Removed intermittent irrigation of indwelling ...
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AUA Comments to CMS 2024 Proposed Medicare Physician Fee Schedule Proposed Rule

By Policy and Advocacy Brief
On July 13, the Centers for Medicare & Medicaid Services (CMS) released the Medicare Physician Fee Schedule (MPFS) proposed rule for CY 2024 (CMS-1784-P). This rule updates payment policies and payment rates for Part B services furnished under the MPFS, as well as makes changes to the Quality Payment Program (QPP). The AUA submitted comments on the proposed rule on September 8 th . Related: View the AUA’s Summary on the proposed rule for the CY 2024 Medicare Physician Fee Schedule AUA’s comment letter specifically addresses the following: Proposed Valuation of Specific Codes for CY 2023 Conversion Factor Update ...
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Insurance Updates: September 3rd – September 9th

By Policy and Advocacy Brief
Each week, the AUA publishes weekly updates on the latest insurance issues pertaining to urology. This week’s update includes the release of policies regarding Prostate Cancer Vaccine, Systems Pathology in Prostate Cancer, Ablative Procedures for Benign Prostatic Hyperplasia (BPH) and Minimally Invasive Benign Prostatic Hyperplasia Treatments, Urinary Tumor Markers for Bladder Cancer, Optilume, Intensity-Modulated Radiotherapy (IMRT): Prostate, Saturation Biopsy for Diagnosis, Staging, and Management of Prostate Cancer, Intensity-Modulated Radiotherapy of the Prostate, Male Sexual Dysfunction Treatment: Nonpharmacologic, Surgical and Minimally Invasive Therapies ...
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Insurance Updates: August 27th – September 2nd

By Policy and Advocacy Brief
Each week, the AUA publishes weekly updates on the latest insurance issues pertaining to urology. This week’s update includes the release of policies regarding Whole Gland Cryoablation of Prostate Cancer, Cellular Immunotherapy for Prostate Cancer, Radiofrequency Ablation of Solid Tumors, Urinary Tumor Markers for Bladder Cancer, and Neuromuscular Blocker Agents. BCBS Alabama BCBS Alabama reviewed Whole Gland Cryoablation of Prostate Cancer with change(s) to supporting information. No changes to criteria. Read the update. Blue Cross Idaho Blue Cross Idaho reviewed Cellular Immunotherapy for ...
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Insurance Updates: August 20th – August 26th

By Policy and Advocacy Brief
Each week, the AUA publishes weekly updates on the latest insurance issues pertaining to urology. This week’s update includes the release of policies regarding Saturation Biopsy for Diagnosis, Staging and Management of Prostate Cancer, Transvaginal and Transurethral Radiofrequency Tissue Remodeling for Urinary Stress Incontinence, Biofeedback and Neurofeedback, Sacral Nerve Neuromodulation/Stimulation, Prostate Biopsies, Urinary Tumor Markers for Bladder Cancer, Penile Prosthesis Implantation, Genetic Testing, Robotic Assisted Surgeries, Urinary Tumor Markers for Bladder Cancer, and Laser Surgery of the Prostate for Benign Prostatic Hypertrophy. ...
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Insurance Updates: August 13th – August 19th

By Policy and Advocacy Brief
Each week, the AUA publishes weekly updates on the latest insurance issues pertaining to urology. This week’s update includes the release of policies regarding Intraurethral Valve Drainage Device for Impaired Detrusor Contractility, Microwave Ablation of Solid Tumors, Prostatic Artery Embolization for Benign Prostatic Hyperplasia (BPH), Urinary Tumor Markers for Bladder Cancer, Urologic Supplies, and Prostate Cancer Screening, Detection and Monitoring. BCBS Illinois, BCBS Montana, BCBS New Mexico, BCBS Oklahoma, BCBS Texas, HCSC BCBS Illinois, BCBS Montana, BCBS New Mexico, BCBS Oklahoma, BCBS Texas, and HCSC drafted a new Intraurethral ...
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Insurance Updates: August 6th – August 12th

By Policy and Advocacy Brief
Each week, the AUA publishes weekly updates on the latest insurance issues pertaining to urology. This week’s update includes the release of policies regarding Split Care Surgical Modifiers, Focal Laser Ablation of Prostate Cancer, Nerve Graft with Radical Prostatectomy, Whole Gland Cryoablation of Prostate Cancer, Cellular Immunotherapy for Prostate Cancer, Transurethral Microwave Thermotherapy (TUMT), Transurethral Water Vapor Thermal Therapy and Transurethral Water Jet (Aquablation) for Benign Prostatic Hyperplasia, Treatment of Urinary Stress Incontinence and Vesicoureteral Reflux, Percutaneous Tibial Nerve Stimulator, Benign Prostatic Hyperplasia Treatments, ...
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Insurance Updates: July 30th – August 5th

By Policy and Advocacy Brief
Each week, the AUA publishes weekly updates on the latest insurance issues pertaining to urology. This week’s update includes the release of policies regarding Genetic Testing, Technology Assisted Surgical Procedures, Saturation Biopsy for Diagnosis, Extracorporeal Shock Wave Lithotripsy, Prostate Biopsies, Sacral Nerve Neuromodulation/Stimulation, Subcutaneous Intravascular Catheter, Autologous Cellular Immunotherapy for Prostate Cancer, and Molecular Biomarkers to Risk-Stratify Patients at Increased Risk for Prostate Cancer. Aetna Aetna reviewed Genetic Testing with changes to criteria, coding, and supplementary information. Changes include, ...
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CY 2024 Proposed Medicare Physician Fee Schedule - In-depth Summary

By Policy and Advocacy Brief
We are excited to share a deeper dive into the CY 2024 Proposed Medicare Physician Fee Schedule (MPFS). The full MPFS linked , along with a fact sheet from CMS for your reference. The AUA has published an in-depth summary of the proposed fee schedule and we will be submitting comments to CMS by the deadline on September 11 th . As mentioned in our high-level summary, below are a few items in the proposal with an impact to urology: · Conversion Factor and Impact on Urology: The 2024 conversion factor to decrease by around 3.36% ($33.89 to $32.75) due to a 0% physician fee schedule update, negative 2.17% RVU budget neutrality ...
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National Study to Document Changes in Physician Practice Expense

By Policy and Advocacy Brief
The American Medical Association (AMA) is undertaking a new national study, supported by 173 healthcare organizations, to collect representative data on physician practice expenses. The aim of the Physician Practice Information (PPI) Survey is to better understand the costs faced by today’s physician practices to support physician payment advocacy. The study will serve as an opportunity to communicate accurate financial information to policymakers, including members of Congress and the Centers for Medicare & Medicaid Services (CMS). The AMA has contracted with Mathematica, an independent research company with extensive experience in survey methods as ...
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Insurance Updates:  July 23rd- July 29th

By Policy and Advocacy Brief
Each week, the AUA publishes weekly updates on the latest insurance issues pertaining to urology. This week’s update includes the release of policies regarding Prostate Cancer Screening, Genetic Testing for Prostate Cancer Prognosis, CPT Category III Codes-Noncovered Services, Genetic and Protein Biomarkers for the Diagnosis and Cancer Risk Assessment of Prostate Cancer, Talzenna, Prostate Specific Antigen, Focal Laser Ablation for Prostate Cancer, and Sexual Dysfunction. Aetna Aetna reviewed Prostate Cancer Screening with changes to supporting information and formatting. No changes to criteria. Read the update. ...
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Insurance Updates: July 16th – July 22nd

By Policy and Advocacy Brief
Each week, the AUA publishes weekly updates on the latest insurance issues pertaining to urology. This week’s update includes the release of policies regarding Transvaginal and Transurethral Radiofrequency Tissue Remodeling for Urinary Stress Incontinence, Gene Expression Profiling and Protein Biomarkers for Prostate Cancer Management, Injectable Bulking Agents, Genetic and Protein Biomarkers for the Diagnosis, and Cancer Risk Assessment of Prostate Cancer, Liquid Biopsy Testing, and Prostate Specific Antigen. BCBS Alabama BCBS Alabama reviewed Transvaginal and Transurethral Radiofrequency Tissue Remodeling for Urinary Stress ...
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Insurance Updates: Week of July 3rd and July 10th

By Policy and Advocacy Brief
Each week, the AUA publishes weekly updates on the latest insurance issues pertaining to urology. This week’s update includes the release of policies regarding Gene-Based Tests for Screening, Treatment of Benign Prostatic Hyperplasia, Sacral Nerve Neuromodulation/Stimulation, Whole Gland Cryosurgical Ablation of Prostate Cancer, Biomarkers for the Diagnosis and Cancer Risk Assessment of Prostate Cancer, Prostate Cancer Early Detection, Erectile Dysfunction, Nerve Graft after Prostatectomy, Sacral Nerve Stimulation as a Treatment of Neurogenic Bladder Secondary to Spinal Cord Injury, and Penile Prosthesis Implantation. Asuris ...
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The Centers for Medicare & Medicaid Services Releases the Calendar Year 2024 Medicare Physician Fee Schedule Proposed Rule

By Policy and Advocacy Brief
The Centers for Medicare & Medicaid Services Releases the Calendar Year 2024 Medicare Physician Fee Schedule Proposed Rule On July 13, the Centers for Medicare & Medicaid Services (CMS) released the Calendar year (CY) 2024 Medicare Physician Fee Schedule (MPFS) proposed rule and accompanying fact sheet. The AUA staff will be reviewing the provisions of the rule and preparing comments, which are due September 11. 2024 Conversion Factor The conversion factor for 2024 is set to decrease by approximately 3.36% from $33.8872 to $32.7476. The proposed conversion factor decrease is the result of a statutory 0% update scheduled for the physician fee ...
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Insurance Updates: Week of June 26th

By Policy and Advocacy Brief
Each week, the AUA publishes weekly updates on the latest insurance issues pertaining to urology. This week’s update includes the release of policies regarding the Evaluation and Treatment of Erectile Dysfunction, Focal Treatments for Prostate Cancer, Tumor Antigen, Prostate Specific Antigen, Prognostic and Predictive Molecular Classifiers for Bladder Cancer, Urinary Incontinence, Sacral Nerve Stimulation, and Tibial Nerve Stimulation (TNS) for Voiding Dysfunction. AmeriHealth AmeriHealth reviewed the Evaluation and Treatment of Erectile Dysfunction (ED) policy with no changes to content. Read ...
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Insurance Updates: Week of June 19th

By Policy and Advocacy Brief
Each week, the AUA publishes weekly updates on the latest insurance issues pertaining to urology. This week’s update includes the release of policies regarding the Treatment of Benign Prostatic Hyperplasia, Vesicoureteral Reflux, Evaluation and Treatment of Erectile Dysfunction, Transurethral Waterjet Ablation of Prostate, Urinary Incontinence Treatment, and Sacral Nerve Stimulation for Pelvic Floor Dysfunction. BCBS Alabama BCBS Alabama reviewed the Treatment of Benign Prostatic Hyperplasia with change(s) to supporting information. No changes to criteria. Read the update. BCBS North Carolina ...
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Insurance Updates: Week of June 12th

By Policy and Advocacy Brief
Each week, the AUA publishes weekly updates on the latest insurance issues pertaining to urology. This week’s update includes the release of policies regarding Urologic Supplies, Sacral Nerve Stimulation for the Treatment of Urge Urinary Incontinence, Temporarily Implanted Nitinol Device (iTind) for Benign Prostatic Hyperplasia, Urinary Tumor Markers For Bladder Cancer, Liquid Biopsy, Nerve Graft Prostatectomy, Focal Treatments for Prostate Cancer, Microwave Ablation of Tumors, Prostate Surgeries and Interventions, and Category III CPT Codes. Aetna Aetna reviewed Urologic Supplies with changes to coding. No changes to criteria. ...
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Insurance Updates: Week of June 5th

By Policy and Advocacy Brief
Each week, the AUA publishes weekly updates on the latest insurance issues pertaining to urology. This week’s update includes the release of policies regarding Sacral Nerve Neuromodulation / Stimulation, Whole Gland Cryoablation of Prostate Cancer, Pelvic Floor Stimulation, Percutaneous and Implantable Tibial Nerve Stimulator, Penile Implants, Radiofrequency Ablation of Tumors, Home Uterine Activity Monitoring, Urological Supplies, Sexual Dysfunction / Erectile Dysfunction, Focal Treatments for Prostate Cancer, and Transurethral Waterjet Ablation of the Prostate . BCBS Kansas BCBS Kansas reviewed Sacral Nerve Neuromodulation ...
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Insurance Updates: Week of May 29th

By Policy and Advocacy Brief
Each week, the AUA publishes weekly updates on the latest insurance issues pertaining to urology. This week’s update includes the release of policies regarding Sacral Nerve Stimulation (SNS) and Posterior Tibial Nerve Stimulation (PTNS), Saturation Biopsy, MRI-Guided Focal Laser Ablation for Prostate Cancer, Penile Implants (Medicare), Condoms, Gene Expression Profiling and Protein Biomarkers for Prostate Cancer Management, Magnetic Resonance-Guided High-Intensity Focused Ultrasound Ablation, Prostate Specific Antigen, Renal Sympathetic Nerve Ablation, and Erectile Dysfunction. AmeriHealth AmeriHealth reviewed Sacral ...
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