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does Medicare cover UroLift procedure

Does Medicare Cover UroLift Procedure?

The prostate gland, which is found in men, is a gland that secretes fluid that nourishes and protects the sperm. When a man reaches the age of 40 or 50, the prostate gland expands.  This enlargement can lead to Benign Prostate Hyperplasia, or BPH. One of the ways to treat BPH is through a treatment called UroLift System.

This leads to many asking the question, “does Medicare cover UroLift procedure?” In this article, we answer that question in clear, plain English. You will also find the average costs of the UroLift procedure.

Does Medicare Cover UroLift Procedure?

The short answer is yes; Medicare will cover the cost of the UroLift procedure. But not 100% of the time. As is often the case with Medicare, certain conditions have to be met in order for Medicare to pay for your UroLift procedure. Below we look at what these are so you know what to expect.

Original Medicare

Original Medicare (Medicare Part A and Part B) provides coverage for UroLift procedures. Coverage for the UroLift procedure is provided by Medicare Part B. However, for Medicare Part B to provide coverage for the UroLift procedure, it must first be considered medically necessary. 

Medicare Part B considers the UroLift procedure as medically necessary if the patient has BPH or at least an enlarged prostate. Aside from the UroLift procedure, Medicare Part B also provides coverage for different procedures and treatments for BPH.

These treatments and procedures may include the following:

  • Greenlight laser
  • Rezum procedure
  • HOLEP prostate enucleation
  • TURP

Medicare Part B also provides coverage for screenings for prostate cancer. Even though BPH is not a likely cause of prostate cancer, the possibility of having both medical conditions is still there. The prostate cancer screening may include an annual digital rectal exam as well as a prostate-specific antigen blood test, or a PSA blood test. 

A digital rectal exam can detect the size of your prostate as well as its shape, and a PSA blood test may help in finding out if your prostate is enlarged if you have a high PSA level. 

Part C Coverage for UroLift Procedure

Medicare Advantage plans (Medicare Part C) also provide coverage for UroLift procedures. These plans mush cover everything Original Medicare covers. However, they offer additional benefits above and beyond that. Each Part C plan is different though so, what each covers and how much you’ll pay for the extra benefits will vary from plan to plan.  

How Much Does UroLift Procedure Cost?

The average cost of a UroLift procedure is about $14,600. However, in some medical facilities, the cost may be closer to half of that average. 

What Is A UroLift Procedure? 

A UroLift procedure is an FDA-approved minimally invasive treatment in which implants are used to hold the enlarged prostate out of the way, treating symptoms of BPH. 

Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.

Additional Info on Medicare Coverage

This article is part of our series on “What does Medicare cover?”

Also, you can check out other articles in this series including: Does Medicare cover telemedicine?

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