Tulsa-PRO Medical Procedure and Medicare Insurance: Important Facts to Consider
The TULSA-PRO procedure, an innovative ultrasound system designed to access the prostate via the urethra and remove diseased tissue, has received Food and Drug Administration (FDA) approval. This non-invasive treatment offers a promising alternative for patients suffering from prostate conditions.
According to the Centers for Medicare & Medicaid Services (CMS), medical professionals should bill TULSA-PRO under CPT code 5X008 or 55882. The American Medical Association (AMA) has assigned a new procedure name for these codes: "Ablation of prostate tissue, transurethral, using thermal ultrasound, including magnetic resonance imaging guidance for, and monitoring of, tissue ablation; with insertion of transurethral ultrasound transducer for delivery of thermal ultrasound, including suprapubic tube placement and placement of an endorectal cooling device, when performed."
For claims relating to the TULSA complete procedure, when carried out by a single physician, CPT code 55882 can be used. If the procedure is performed by two physicians, CPT code 55881 is advised. Similarly, for TULSA device management, CPT code 51721 can be used when the procedure is carried out by two physicians.
While the details of the TULSA-PRO procedure costs are currently unavailable on Medicare's procedure look-up site, approximate out-of-pocket costs for a similar procedure (Focused ultrasound ablation/therapeutic intervention) are $1,637 in an ambulatory medical center and $1,632 in a hospital outpatient department, according to Medicare's 2024 national average data.
However, Profound Medical, the developer of the TULSA-PRO system, states that the procedure may cost between $680 and $12,992. It's essential to note that these figures may vary depending on the specific circumstances of each case.
In conclusion, the TULSA-PRO procedure offers a promising non-invasive treatment for prostate conditions. Medical professionals should bill the procedure under CPT codes 5X008, 55882, or 55881, depending on the number of physicians involved and the specific procedure being performed. The costs associated with the TULSA-PRO procedure may vary, and it's advised to consult with healthcare providers for more detailed information.
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