HIFU not being covered by Medicare Advantage Plans Despite Medicare Reimbursement Code

Last year, in July 2017,  the Centers for Medicare & Medicaid Services (CMS) issued a reimbursement code that may help some HIFU patients cover part of the expense of paying for the HIFU treatment. This was great news for Medicare patients who were looking for a way to get reimbursement for some of the cost of the procedure.Medicare Advantage Plans not covering HIFU for prostate disease.Not only that, this reimbursement code marks a significant milestone as it means that HIFU as a treatment for localized prostate diseases, like BPH and prostate cancer,  is becoming more accessible to men in the US and to physicians interested in providing their patients with non-invasive treatment options.


Unlike other “traditional” treatments for prostate disease, such as surgery or radiation, HIFU is much less invasive. There is little to no blood loss, much lower risk of side effects such as impotence and incontinence and it is an outpatient procedure where patients return to their normal lifestyle almost immediately.

The fact that CMS has issues a code for Medicare patients to get reimbursement is wonderful news for men with prostate disease, because it gives them the opportunity to select, and potentially be reimbursed for, a less invasive option for treating prostate disease. This means they can choose HIFU, thus selecting a non-invasive option that allows them to preserve their quality of life.

Unfortunately, the same option to choose HIFU and get reimbursed does not apply to patients who have a MedicareAdvantage Plan.  Patients who choose HIFU for prostate disease are discovering that they are being denied any type of reimbursement through their Medicare Advantage Plan. Despite HIFU ablation of the prostate being covered by Medicare, the Medicare Advantage Plans are denying coverage. This could change as HIFU is adopted by commercial insurers that administer these plans.

Of course, these patients can appeal the decision but there is no guarantee and the decision is troubling due to the fact that Medicare is in fact issuing reimbursement to patients for Part Medicare B.

Although the enrollment period closed in December, if you are a man and comparing Medicare plans, make sure you consider the side effect caused by treatments forced upon you because of your selected plan.

Interested in learning more about HIFU and Medicare reimbursement? Click here. 


Comments are closed.